A 24 Hour Clinically Integrated Acute Management System for New Zealand

Date of publication: March 1998

Note
This draft document is a follow on from the Tertiary Services Review that the Ministry undertook in 1994, and it is also based on a several existing reports:

• Guidelines for a Structured Approach to the Provision of Trauma Care (May 1994) Royal Australasian College of Surgeons, New Zealand Trauma Committee, a trauma project for the Ministry of Health; and

• A National Air Ambulance Network for New Zealand (December 1996) A scoping report for the ACC and the combined RHAs.

Introduction

Access to acute services: The key requirement of publicly funded health services
New Zealand is similar to other Western countries in moving toward greater centralisation of surgical services. There are a number of reasons for this trend:

• an increasing focus on quality. This has resulted in a focus on volume quality issues and questions being raised about the adequacy of peer review in smaller facilities with low surgical throughputs and small numbers of clinicians.

• advances in technology. Due to the high cost of these technologies and the specialist skills required to operate them, new technologies are generally concentrated in the larger hospitals.

• medical advances have lead to a decreasing focus on some of the surgery commonly undertaken by the smaller facilities, for instance the majority of varicose vein cases can now be treated using non-surgical interventions.

• changes in service delivery methods, such as increasing use of out-patient and day stay surgery, have lead to a reduction in emphasis on in-patient hospital stays overall.

The above factors affect the clinical and financial viability of 24 hour in-patient surgical services in smaller hospitals. As a result some of these facilities may face losing 24-hour access to these services.

In this environment of change we are concerned about ensuring New Zealanders have ready access to acute services. Acute services comprise those services required to manage: trauma; medical and surgical emergencies; and complicated births. Ready access to trauma services is commonly acknowledged as essential in achieving good health outcomes for patients with severe trauma. In addition, the clinical working group involved in this piece of work considers that ready access to services required to manage other acute health needs is also essential in achieving good health outcomes.

Due to the importance of ensuring access to these services the Minister of Health has requested the Ministry of Health undertake work on the optimal location and organisation of 24 hour acute / emergency services. Clinical safety is the key to this work.

This is the Ministry's initial report. The purpose of the report is to outline a system whereby New Zealanders can gain easy access to acute services in the face of service change. It is a concept paper and amounts to the initial thinking of a clinical working group. Additional work is required on developing and implementing the 24-hour clinically integrated acute management system (the acute management system). The additional work required is detailed in section 5 of this report.

This report is a first draft of the Ministry's work. The following areas of the report require further work before it can be finalised:

• the hospital service levels require further development and clinical validation; and

• the report needs to be discussed with relevant parties.

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Updated 27 April 1998