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Fast stream elective surgery for Waitemata residents closer

18 December 2012

Fast stream elective surgery for Waitemata residents one step closer

The Waitemata District Health Board’s bid to provide public elective surgical services faster and more efficiently for its population has moved one step closer.

Following an extensive consultation programme with clinicians and the unions representing medical staff, the Board of Waitemata DHB has decided to implement the ‘package of care’ model at its $39 million Elective Surgery Centre (ESC), currently under construction at North Shore Hospital and due for completion in July 2013.

“Our aspiration for the project is to create a high quality, highly efficient and cost effective centre for fast stream elective surgical services – one where the patient is the absolute priority and which would be New Zealand’s most productive, with results better than that achieved in both private and other public hospitals in the country,” says Waitemata DHB chairman Dr Lester Levy.

Under the ‘package of care’ model, surgeons and anaesthetists are paid a single fee for the entire patient episode. For the surgeon, this includes undertaking the operation and all of the post-operative care for up to six weeks.

The model is a specialist led and delivered service. The surgeons and anaesthetists participating in the ‘package of care’ model are Waitemata DHB staff who undertake this in addition to their normal duties at the DHB.

Waitemata DHB has been piloting the ‘package of care’ model since 2010 at Waitakere Hospital. The results of the pilot, which have been subject to extensive internal and external review – including by the University of Auckland’s Professor Toni Ashton – found that the Waitakere pilot resulted in:

reduced theatre times, enabling for 20-30% more surgeries to be performed over the same period of time
patients spending less time in hospital, as they recovered faster
savings in surgical costs
high levels of staff and patient satisfaction

“The ESC will essentially allow us to do more surgery at less cost – ultimately it is our patients and our population that will benefit,” says Dr Levy.

Waitemata DHB CEO Dr Dale Bramley says the need for additional surgical capacity and new models of care are very real.

“We have the largest and second fastest growing population of all 20 DHBs in New Zealand. It is also a population that is aging at a rapid rate. Combined, these factors create an ever-increasing demand for both acute and elective surgery.”

ESC director and orthopaedic surgeon Dr John Cullen says under the ‘package of care’ model, patients will be looked after by the same medical team throughout their procedure and hospital stay, which is important to long-term care and patient satisfaction.

Dr Cullen, who also led the Waitakere pilot, says one of the key aims of the ESC is to provide elective surgery at 80% of the national price (the average price for a particular procedure to be performed anywhere in New Zealand), while maintaining a high standard of care.

“The Waitakere pilot which involved a number of surgical specialties – including orthopaedic, general surgery, urology, otorhinolaryngology (ear, nose and throat) and gynaecology – all achieved costs within the target 80% of national price.

“The ‘package of care’ model allowed Waitemata DHB to reduce the amount of work previously outsourced to the private sector at a higher cost, providing savings of approximately $3.5 million per year which has been invested in further elective surgery.”

Dr Levy says the Board of Waitemata DHB, in making its decision, had given consideration to alternative remuneration models, including those put forward by the Department of Anaesthesia and a payment model based on the senior medical officer national collective agreement.

“Unfortunately, the alternative proposed models were not sufficiently developed at this time to demonstrate that they could achieve the same results as the ‘package of care’ model.”

“Given that the ESC is due to open in July next year, the Board felt it prudent to go with the proven ‘package of care’ model at this time,” says Dr Levy, “As a Board we remain open-minded to alternative models should they be able to achieve the same results. The Board has agreed therefore to receive alternative proposals for trialling within the DHB when feasible alternatives are fully developed.”

Once completed in July 2013, the ESC will provide Waitemata DHB with four more operating theatres, 40 inpatient beds, a post-anaesthesia care unit, six outpatient consulting rooms and four pre-admission assessment rooms.

It will be one of the most medically advanced elective surgery centres in New Zealand, and will be staffed by a workforce of around 80 people.

As a dedicated elective surgery facility, the centre will significantly reduce the time patients wait for non-urgent surgery.

It is proposed that patients will receive a surgery date at the time of their first consultation, significantly reducing both pre- and post-surgical visits. In most cases, patients will need only one visit to hospital prior to surgery and will have greater certainty around their treatment times.

The ESC is expected to undertake nearly 6000 operations per year, with approximately 25% of those being additional operations.


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