13 February 2006

Top ideas line up for Health Innovation Awards

A scheme to take the fizz out of school tuck shops is one of the entries short-listed for New Zealand’s top health and rehabilitation awards.

Entries targeting obesity and diabetes feature strongly among the 25 finalists for the 2006 New Zealand Health Innovation Awards.

Beverages Guidelines developed by Waitemata District Health Board use a ‘traffic light’ system to indicate the healthiest drinks schools can stock for their students.

Other finalists include an exercise campaign encouraging West Coasters to ‘get up and get moving,’ a Ngati Porou programme to beat diabetes that involves the East Coast rugby team and a popular Pacific lifestyle programme getting great results in the Hutt Valley.

The awards are a joint initiative between ACC and the Ministry of Health, to promote excellence in health treatment and rehabilitation services. They recognise and reward those working in the health sector to develop better products, services and processes.

“Tackling obesity and diabetes are top priorities for me,” Health Minister Pete Hodgson said. “It is very encouraging to see such effective programmes being put into place right across New Zealand. All these finalists are excellent examples of health professional recognising what is needed in their particular area and acting proactively to doing something about it.”

ACC Minister Ruth Dyson said: “Yet again the finalists for the Health Innovation Awards demonstrate the quality and diversity of work which is contributing to better health care and recovery for all New Zealanders. It is great to be able to recognise, through these awards, the innovative thinking and ingenuity of people who care.”

Last year’s overall winner was Auckland’s Healthy Housing programme, a project to reduce the risk of housing-related diseases among families living in Housing New Zealand Corporation properties.

The finalists were chosen from 111 Expressions of Interest in November and have now submitted formal applications for evaluation and judging. The New Zealand Business Excellence Foundation manages the independent evaluation process, using international criteria.

The winners will be announced on June 29, 2006, at an awards dinner and presentation in Wellington. The Supreme Award winner receives $15,000, with cash prizes of $8000 each for the best entries in other categories.

Profiles and contact details for the 25 finalists are attached.

Finalists for the 2006 Health Innovation Awards

Attention News Editors: The finalists include entries from Auckland, Gisborne, Hamilton, Tauranga, Rotorua, Palmerston North, Wellington, Christchurch, the West Coast, Dunedin and Southland.

Auckland
Beverage Guidelines a first in child obesity programme
In a New Zealand first, guidelines are helping reduce the almost six kilograms of sugar the average kiwi child drinks each year.

One in three New Zealand children is overweight or obese and more than a quarter of an average child’s daily sugar intake comes directly from what they drink.

Formulated for schools, the Beverage Guidelines use a ‘traffic light’ system that shows the healthiest drinks schools can stock for their students.

Beverages from the green category are a healthier choice, offering some nutritional value and containing fewer kilojoules than ‘amber’ or ‘red’ drinks.

‘Red’ beverages -- such as full-fat milk drinks and sweetened fizzy drinks -- have limited nutritional value.

The guidelines encourage schools to replace ‘red’ beverages with amber or green category drinks.

Waitemata District Health Board developed the guidelines and the National Heart Foundation of New Zealand reviewed them.

Thirteen Waitemata secondary schools and one primary school took part in the project in 2005. More schools are expected to take part in the scheme.

The Beverage Guidelines are part of a comprehensive approach the DHB is taking to tackle New Zealand’s childhood obesity epidemic.

A second project – the Wellbeing in Schools programme is addressing physical activity and other nutritional factors.
Contact: Bryony Hilless 09 486 1491
Email: bryony.hilless@waitemataDHB.govt.nz

Improved acute medical and surgical assessment
A streamlined admission process at Auckland City Hospital is providing improved care for patients, reducing delays and saving inpatient beds.

The changes at the hospital are attracting interest within New Zealand and overseas.

When inpatient services at Greenlane and National Woman’s Hospital closed there was an increase in patients presenting acutely to the new Auckland City Hospital.

They developed an Admission and Planning Unit to improve an admission process that at times was cumbersome, inefficient and involved the double handling of patients.

The 45-bed unit, run by Inpatient Services, provides rapid assessment, investigation and treatment. Patients are admitted if necessary, discharged if not. Next to the Emergency Department, the unit accepts medical and surgical acute admissions.

Patients who have already been seen by their GPs or an accident and emergency clinic and do not require emergency treatment are sent directly to the unit after a triage assessment in the Emergency Department.

This prevents double handling in the Emergency Department and saves nursing and medical time. Taking the load off the Emergency Department has also prevented “corridor medicine”. Almost half the patients admitted to the unit are discharged within 36 hours, and 18,000 bed days were saved in one year.

Although similar units operate in Australasia and the United Kingdom, most are for medical patients only and do not allow direct access from the community. The Auckland unit is now recognised as the Australasian benchmark. Numerous visitors from Australia, the UK and New Zealand have visited the unit, hoping to develop similar facilities at their hospitals.
Contact: Dr John Henley 09 379 7440
email: JohnH@adhb.govt.nz

Cornerstone – general practice accreditation programme
A quality improvement programme is setting the standard for patient care in every general practice in New Zealand.

Cornerstone, developed by the Royal New Zealand College of General Practitioners (RNZCGP), helps practice teams work together to identify improvements, plan changes and take action to improve their practice.

Practice teams start their own quality improvement regime by assessing themselves against Aiming for Excellence - the RNZCGP Standards for General Practice Care. These were developed through a wide multidisciplinary group, and cover the quality needs of the three key stakeholders: patients, professionals and practices.

Following the practice's own improvement processes, teams of independent assessors with GP, practice nurse and practice manager experience provide an independent review. They explore their findings and further opportunities with the whole practice team.

By December 2005, 55 of the estimated 950 general practices around New Zealand had received Cornerstone accreditation and a further 245 were undergoing their own initial reviews.
Contact: John Wellingham 09 486 8920
email: jwellingham@cmdhb.org.nz

On TRACC -Transcultural and intersectoral care centre
Refugee children with problems are now benefiting from an integrated transcultural service in Auckland.

The centre brings together relevant agencies to provide a coordinated and culturally appropriate service for children with severe behaviours, mental health or care and protection needs.

On TRACC is a collaborative pilot project, funded by the High and Complex Needs Unit - a joint initiative of the Ministries of Health, Education and Child, Youth and Family, to improve outcomes for children and young people with high and complex needs through effective inter-agency service collaboration.

The pilot scheme has developed effective service delivery practices and promotes refugee issues within the government departments working with them. It is also helping to determine the most cohesive way for departments to deliver services to refugee communities.

The lessons learnt from the pilot will contribute to the existing information known regarding the complexities of working effectively with refugee populations and their unique requirements.

An evaluation of the service shows the benefits gained from attendance at the centre include a reduction in the severity of symptoms of trauma and participation and achievement in education, management of youth offending, mental health issues and care and protection needs.

On TRACC is the first scheme developed in New Zealand to provide a comprehensive transcultural and integrated service for refugees. The pilot has helped improve existing service responses in government agencies.
Contact: Peter Shaw 09 307 4949
email: pshaw@adhb.govt.nz

Advanced Wound Care
Access to specialist care means speedier recovery for patients with painful and debilitating wounds.

Treating serious wounds is costly and recovery can take months, sometimes years. Wound nurse specialist Amanda Palmer is helping to change that.

The Advanced Wound Care Project is a joint initiative between Auckland’s HealthWest primary health organisation (PHO) and Amanda’s Wound Management Consultancy.

If a practice nurse or GP feels that a patient needs specialist assessment or treatment, they call in Amanda. This has a two-fold effect. Not only does the patient receive specialist care but the practice nurses and GPs also have the opportunity to learn.

Amanda provides wound management education, advice and support. Twenty-five practice nurses have studied how to manage complex wounds.

Before the programme was available, patients complained of wounds taking a long time to heal.

With Amanda’s care, the average healing time is now nine weeks and patients are more satisfied with their treatment. They need fewer visits to the doctor, experience better continuity of care and feel more involved in the management of their wounds.

Amanda is now spreading the word across the country. She has helped to develop The Compression Therapy Service Project for ACC-related lower leg wounds. Based on the Wound Care Project, this service has been extended to include other specialist practitioners around the country.
Contact: Amanda Palmer 027 443 2546
email: Amanda@woundmanagement.co.nz

Organisational Change Management – Making a Case for Change;
A Clinical Governance Tool
A page on a patient’s electronic medical record allowing nurses to identify patients with potentially high risk medical conditions is improving healthcare for thousands of patients in South Auckland.

About 90-95 percent of medical errors are from faulty processes rather than mistakes by a health professional.

People are quick to point the finger at health professionals and this culture of blame can reduce willingness to report errors or near misses. The opportunity to share lessons learnt is also missed.

A proactive approach to reducing the potential for mistakes helps safeguard high standards of care.

The Triage Template is a page in the patient’s electronic medical record that allows nurses to identify any patients who present with potentially high risk medical conditions such as chest pain, shortness of breath or severe allergic reaction. Relevant findings from examining the patient are recorded for the doctor.

The Triage Template allows an easy audit of the level of care provided for these patients.

The Triage Template was piloted for a month in three of East Tamaki Healthcare’s eight surgeries. After evaluation, the template was modified and rolled out to all East Tamaki Healthcare’s surgeries.

The template was designed by Dr Richard Hulme, Director of Clinical, Quality & Continuing Medical Education at East Tamaki Healthcare.

East Tamaki Healthcare provides care for more than 70,000 patients in South Auckland.
Contact: Dr Richard Hulme 021480111
email: Richard@ethc.co.nz

Gisborne
Ngati and Healthy - Diabetes prevention project
A community health project tailored to the lifestyle of remote East Coast communities is tackling high rates of diabetes among Maori.

Traditional ‘boil ups’ are out and gathering food from the sea and the bush becomes part of an exercise programme in the Ngati and Healthy project. The East Coast Rugby team even act as role models to promote a healthy lifestyle.

Ngati and Healthy is a collaboration between Ngati Porou Hauora, the major health care provider for the largely Ngati Porou communities living north of Gisborne, and the University of Otago’s Edgar National Centre for Diabetes Research.

Of 247 people randomly selected for the project, more than half were at risk of developing diabetes or already had it.

Twenty-two people had diabetes they knew about and a further 11 people were identified as having diabetes. Eleven people had impaired glucose tolerance, and 91 people were insulin resistant.

The programme’s strength is its focus on the community as well as the individual. Health indicators such as blood pressure, weight and waist measurements are monitored, but the programme also includes nutrition and exercise programmes that suit the East Coast Maori lifestyle.

Researchers are also trying to make healthy foods such as wholegrain bread easier for people to access.

The Ngati and Healthy project is taking place in coastal communities with a population of approximately 6000. It will run for two years.
Contact: Terry Ehau 06 8646 803
email: terry.Ehau@nph.org.nz

Hamilton
Design and implementation of CostPro, an activity based costing system and patient data warehouse
A New Zealand-developed system for costing health services is helping district health boards save thousands of dollars.

CostPro also provides the Ministry of Health with the data to determine accurate figures about health costs.

Costing and Business Solutions, a specialised consulting firm that develops and implements systems for health care organisations, developed CostPro.

Accurate costing is vital to the Ministry of Health, DHBs, clinicians and managers as budgets are constantly being juggled to ensure health dollars are spent wisely.

The CostPro system spans an entire organisation to provide accurate cost information of the business right down to an individual patient’s stay.

Seven DHBs have adopted CostPro over the last three years. In many cases, it has replaced an American system that was more expensive, not user friendly and slower.

Hospitals are reporting cost savings and identifying revenue opportunities of about $100,000 to $300,000 a year.

Reports are also easier to extract from CostPro and are produced in less time than under the old system.

CostPro also provides the Ministry of Health with detailed patient costing data for the determination of national prices.

Analysts use the system extensively to report on patient treatment patterns, length of stay analysis, profitability of contracts and department productivity.
Contact: Ross Wilson 021 527 007
email: ross@cbsnz.com

Rotorua
Options for Patient Treatment
Patients in Rotorua are enjoying hospital treatment at home.

The Options for Patient Treatment (OPT) scheme provides free services to patients. It was developed by the Rotorua General Practice Group to improve patient access to healthcare and to plug some gaps in the services previously provided.

The range of patient conditions being treated at home is expanding and includes cellulitis, deep vein thrombosis and elderly people who have had falls.

Patients are referred from general practice, from the Emergency Department, or from the hospital through early discharge. They receive clinically and culturally appropriate home assessment and treatment.

Pacific people and Maori, who are often reluctant to go to hospital seeing it as a place to die rather than a place to get better, really appreciate this option.

Rotorua Hospital is also saving bed space for urgent patients and the Emergency Department can refer patients who would not be admitted as emergencies but are unable to cope at home.

The OPT scheme also means people in rest homes can be cared for without having to go into hospital and ACC is benefiting from reduced costs of patient care.

Rotorua General Practice Group is a health management organisation that works in partnership with family doctors and their practices. The partnership includes 16 urban practices and one rural practice, and involves 64 GPs and 63 practice nurses.
Contact: Fiona Thomson 07 349 3563
email: fthomson@rgpg.co.nz

Tauranga
Patient driven outcomes in joint replacement surgery – immediate and long-term analysis

Orthopaedic patients are partners in their own assessment process in the Bay of Plenty.

In a New Zealand first, the Bay of Plenty District Health Board is using a system set up by a group of local orthopaedic surgeons to help prioritise the treatment process for patients.

The Tauranga Orthopaedic Research Society Inc (TORSI) was created by the eight orthopaedic surgeons in Tauranga to study the outcomes of their orthopaedic surgeries.

Patients assessed by an orthopaedic surgeon as needing hip or knee joint replacement surgery complete scientific assessment forms.

These internationally recognized scoring tools record their health and wellbeing, the level of their joint pain and stiffness, and their ability to perform tasks of daily living with their affected joints.

By completing the surveys before and after their surgery, the patient’s subjective outcome is measured and added to the clinical assessment made by the surgeons.

This recognizes that the most important assessment of the result of joint replacement surgery is how the patient feels about it.

To date, almost 1500 patients have been scored, including more than 600 DHB patients who have been prioritized for treatment.

The orthopaedic surgeons also use the scoring system for the long-term follow up of their joint replacement patients. This allows long-term surveillance of patients over the lifetime of their artificial joint. The system used is unmatched by any other in New Zealand.
Contact: Tony Lamberton 07 571 5090
email: tonyl@joints.co.nz

Palmerston North
The safe and efficient disposal of unused medicines
A successful scheme to remove excess medicines from the home and dispose of them safely is also providing valuable information about what is being returned and why.

Central Pharmacy in Palmerston North set up the medicine return and disposal system.

In one year, people returned 8095 items, including 500 different kinds of medicines. The returned medicines cost around $130,000. The most expensive returned item cost $512.

The number of returns is likely to treble this year, removing a vast amount of medicines from harm’s way.

Poisoning accounts for about one in five of all accidents involving preschoolers.

People return their unused medicine to their local pharmacy and fill in a questionnaire about who the medicine was for and why it was unwanted.

Central Pharmacy found over half of the medicines had been dispensed "stat" (in one lot), and on average 69 percent of the dispensed medicine was returned.

The scheme operated for a year in Palmerston North and now covers the MidCentral DHB region.
Contact: Susan Judd 06 3587283
email: central.pharmacy@xtra.co.nz

Hutt Valley
Lifestyle Pasifika – Getting Healthy the Pacific Way
A popular Pacific lifestyle project is seeing great results in the Hutt Valley.

The 12-week Lifestyle Pasifika programme targets diet and exercise in a way that suits Pacific people, including one woman who lost 120kg.

Boiling corned beef in the can and pouring off the fat is just one example of the healthier cooking options shared.

Local GPs and other health providers refer people to the weekly education sessions on nutrition, cancer awareness, heart disease and physical activity.

An hour-long exercise class follows the education sessions,

The key to the programme’s success is tailoring sessions to the Pacific lifestyle. The programme features Pacific dancing and is designed as a community activity.

Sessions are conducted in different Pacific languages and held at five locations throughout the Hutt Valley.

Lifestyle Pasifika is so popular that some people follow the programme around, attending classes at all the locations.

The education sessions attract between 40 and 80 people and include budget cooking ideas and shopping advice at the local supermarket. There are also demonstrations of healthy cooking options for traditional island foods.

Nearly 900 Hutt Valley people have completed the 12-week programme and 3000 people have been part of the exercise programme.

*A 40-year-old Samoan woman referred to the programme was unable to understand the implications of her diet and lifestyle on her health and the benefits of prescribed medication. She had type II diabetes, osteo-arthritis, obesity and hypertension. She lived alone, shuffled along with a walking frame, was unable to use stairs, was confined indoors and no longer working. She now gets around unaided and is an active member of her community. She is a very positive advocate for the programme and is currently looking for employment. In a year, she reduced her weight from 262 kgs to 142kgs.
Contact: Siloma Masina 04 570 9541
email: Siloma.Masina@huttvalleydhb.org.nz

Wellington
Real time patient management system for Intensive Care Unit
A type of electronic medical record being used for the first time in an intensive care unit in New Zealand is helping to provide better care at Wellington Hospital.

With around 1200 admissions to the hospital’s Intensive Care Unit (ICU) each year, good information is vital for the 14 doctors and 100 nurses and support staff who work there.

The patient management database was developed by one of those doctors, intensive care unit specialist, Dr Peter Hicks.

The real time nature of the database and its integration into the daily work of the Intensive Care Unit is unique in New Zealand.

Middlemore Hospital in Counties-Manukau now uses it and it is a model for the development of other intensive care systems in Australia and New Zealand.

The program works by maintaining a list of all current patients in ICU. The system’s primary role is to provide printed admission and discharge reports and detailed clinical handover reports for each shift of staff.

The streamlined system has also produced other advantages not possible with traditional patient database systems. It has allowed immediate audit of patient care, which can be done in staff meetings using a data projector.

Many other unit activities have been added to the system as its potential was realised. These have included a bereavement follow-up service, research studies, auditing tracheotomies, providing feedback for other units and GPs as well as doing drug calculations.

There has been a strong emphasis on using the system for quality assurance.
Contact: Peter Hicks 04 3855946
email: marion.corke@ccdhb.org.nz

Computer software program revolutionises manufacture of chemotherapy
A new computer system that streamlines the manufacturing process for chemotherapy is providing improved safety for cancer patients at Wellington Hospital.

The hospital’s pharmacy production unit provides chemotherapy in a ready to administer form for oncology, haematology, rheumatology, ophthalmology and women’s-health patients.

Preparation of chemotherapy is a labour intensive process and involves many steps in documentation, clinical checking and manipulation.

In the past, much of the work was performed manually and was time consuming, detracting from the actual manufacturing process. The manual system was inefficient and increased the potential for medication errors.

A unique computer software program designed to meet the requirements of the pharmacy production unit has changed all that.

The new system is integrated with inventory and improved stock control.

Documentation is computerised and generated automatically. Supportive information is provided at the point of manufacturing and provides a quality assurance check for the dispensing process.

The software has improved workflow efficiencies and reduced documentation workload.

It has improved reporting from a financial and clinical perspective and also increases safety, with better decision support within the system. Decision support provides user prompts for dose checks and user access to complex information about product stabilities.
Contact: Karen Corban 04 3855 999
email: Karen.corban@ccdhb.org.nz

Valid, transparent and fair decision-making processes for access to elective health care
Deciding who gets publicly-funded heart surgery is difficult but the use of world-class internet based software is providing a fairer system for patients.

Prioritising patients through waiting lists or a booking system is a challenge faced by all health services internationally.

New Zealand has developed a points system that includes criteria for prioritising access to elective services. This provides a standardised decision making system.

Criteria for prioritising access to coronary artery bypass surgery were drafted by cardiologists and cardiac surgeons and then pre-tested and refined using the Point Wizard software.

Clinicians’ preferences with respect to acceptable trade-offs between the criteria were then incorporated in the points system.

The initiative is a collaboration between Point Wizard, a developer of software for decision making and prioritisation, the New Zealand region of the Cardiac Society of Australia and New Zealand and the Ministry of Health’s elective services prioritisation team.

The software has shown there is a wide variety in the decisions made by individual doctors. The new system ensures fairness to patients by improving consistency and reliability..

Work on new or revised points systems for hip and knee replacements, vascular surgery, gynaecological and infertility treatments is well underway.

The goal is to develop fully integrated prioritisation processes supported by information technology.
Contact: Franz Ombler 04 934 5737
email: franz@pointwizard.com

Christchurch
Heart failure rehabilitation - New Zealand's first dedicated programme
New Zealand's first dedicated exercise and education programme for people with chronic heart failure is helping Cantabrians enjoy a better quality of life.

Cardiovascular disease is the leading cause of death in New Zealand, accounting for four in 10 deaths.

Chronic heart failure is the end stage of heart disease and is common among older people. Patients are often breathless and tired and can do little exercise.

Physiotherapists at Christchurch Hospital developed the Heart Failure Rehabilitation Programme because existing interventions did not meet the specific needs of patients with chronic heart failure.

The first three-month Heart Failure Rehabilitation Programme started in January 2005. Exercise capacity and quality of life was measured for each of the 18 participants.

After completing the programme, all the participants had maintained or improved their ability to exercise. This also helped with their ability to perform everyday activities.
Levels of anxiety and depression were also significantly lower in those at risk. Quality of life was significantly improved for four out of five participants.

Readmissions to hospital account for 75 percent of the cost of treating heart failure.

Twelve months after starting the programme, none of the participants had been readmitted to hospital with heart failure-related conditions.

The programme’s success means it is set to continue .
Contact: Sarah Fitzgerald 03 3640 680
email: Sarah.fitzgerald@cdhb.govt.nz

A system allowing target controlled delivery of volatile anaesthetics
An improved system for administering anaesthetics is saving money and may mean more rapid recovery for patients at Christchurch Hospital.

About 400,000 people have an anaesthetic each year in New Zealand. Small improvements for each of them may have a big effect on health care overall.

The system was developed at Christchurch Hospital’s Department of Anaesthesia and allows anaesthetists to more directly match delivery of inhaled anaesthetics with the needs of a patient.

By better matching drug doses to needs, the system can help reduce side effects, modify the effects of surgical stress and see patients recover from anaesthetic faster, potentially leading to reduced complication rates and earlier discharge.

As a patient goes to sleep and wakes and throughout an operation, the amount of anaesthetic they need varies. Too little anaesthetic risks awareness or undue stress for the body; too much anaesthetic can delay recovery and may have adverse long-term effects.

The new system helps anaesthetists reduce the delay between changes in the doses of anaesthetics being administered and the changes taking effect.

The system uses settings on the anaesthetic delivery system, data from patient monitors and mathematical models. Brain levels are calculated and future anaesthetic levels in the blood and the brain are estimated and displayed.

By altering the system’s settings of the anaesthetist can rapidly determine the optimum settings to meet a patient’s needs at different times.

The changes have produced savings of $240,000 in one year without reducing patient care.
Contact: Dr Ross Kennedy 03 3640 288
email: ross.kennedy@chmeds.ac.nz

Blood usage project – red blood cells making a little go a long way
A new system for ordering and issuing blood from Christchurch Hospital’s blood bank is making the best use of a precious resource.

The Canterbury District Health Board Transfusion Committee set up the project after reviewing red blood cell use data and realising the relocation of the New Zealand Blood Service’s (NZBS) blood bank to the main hospital site provided an opportunity to make changes.

The process for ordering and issuing blood was revised and an education programme was conducted with clinical staff on 'best practice' in blood transfusion practices. The project has saved Canterbury DHB $251,000 in one year.

The project focused on ordering red blood cells appropriately. This led to less blood being returned as well as an overall reduction in blood usage.

Fewer units of blood were transfused, with no reported effect on patient or clinical safety.

The changes have reduced the amount of red blood cells held and have allowed more accurate stock management of red blood cell supplies by the NZBS.

The blood usage project team consisted of a collaborative group involving Canterbury District Health Board Medical and Surgical Clinical Staff and New Zealand Blood Service staff.
Contact: Felicity Woodham 03 364 1542
email: Felicity.woodham@cdhb.govt.nz

Improving communication efficiency - Vocera Paging pilot at
Christchurch Hospital Emergency Department
A paging system trialled at Christchurch Hospital is saving time and money and increasing staff and patient safety.

The United-States developed Vocera paging system saves an estimated 17 hours of staff time every day and has led to productivity gains of about $155,000 a year.

Christchurch Hospital's Emergency Department spreads across four separate geographic areas. At peak times, more than 30 staff members are caring for up to 70 patients.

Wasting less time walking around looking for staff has freed up time for more productive work.

Staff wear a small voice-activated pendant that allows hands-free ability to answer calls.

Each staff member wears a badge on duty and can instantly call or locate any other user. Calls to internal and external phones are made directly from the badge.

The time it took to physically seek out a staff member within the emergency department was estimated at 3.4 minutes. With Vocera, it is now less than a half a minute.

The new paging system also increases patient safety by enabling rapid communication when necessary. Staff can summon help quickly if a patient's condition deteriorates.

Vocera also provides improved staff safety, with instant communication when there is a threat of interpersonal violence.
Contact: Paul Gee 03 364 0270
email: paul.gee@cdhb.govt.nz

The SPRINT Protocol for tight glycaemic control in critically ill patients
A world-leading development by medics and engineers at Christchurch Hospital is helping to save lives and may soon be trialled overseas.

It is estimated that more than 150 lives and $3 million could be saved every year in New Zealand if diabetes was better controlled in intensive-care patients.

Up to one in three intensive-care patients suffers from a form of stress-induced diabetes.

The team, including engineering students from Canterbury University, has come up with a system for tightly controlling blood-sugar levels in Christchurch Hospital’s sickest patients.

The SPRINT system, Specialised Relative Insulin Nutrition Tables, helps to safely and predictably regulate glucose levels.

The stress of critical illness causes increased glucose production, reduced insulin secretion and increased insulin resistance. Critically ill patients need feeding if they are to survive but this risks worsening the problem.

The SPRINT system was cheap to put in place and is simple to use.

It involves a simple spinning cardboard wheel that tells a nurse quickly and accurately how much insulin to administer and how much food to allow a patient, depending on their body size and latest blood-sugar reading.

It enables staff to monitor patients and quickly respond to unfavourable blood-sugar levels every one or two hours.

The system has now been used on 66 intensive-care patients at Christchurch Hospital, and has already reduced deaths by 30 percent in patients who spent less than three days in intensive care.

This system has also dramatically reduced the risk of low blood sugar with only 0.1% of patients experiencing ‘hypos’.

Trials of the sprint system are planned in Denmark and Melbourne.
Contact: Geoffrey Shaw 03 364 1077
email: Geoff.Shaw@cdhb.govt.nz

Mental health screening in a women’s prison
Twice as many female prisoners have been identified as needing treatment for mental health problems or suicide risk after trials of an improved screening system at Christchurch Women’s Prison.

Nearly one in four of almost 500 women prisoners screened positive during the one- year trial at the prison.

Screening was so successful it has continued after the trial and work is now underway to develop a national screening process at all New Zealand prisons.
It is estimated that nearly 60 percent of prisoners suffer at least one diagnosable mental disorder and 10 percent will need specialist mental heath care while in custody.

The screening at Christchurch Women's Prison involves adding additional questions to the routine health check carried out when women enter prison.

All prisoners who may have mental health issues are referred to a psychiatric nurse for triage assessment.

The trial doubled the number of patients needing follow up and specialist treatment for mental health problems or suicide risk and tripled the number being triaged.

Many prisoners were referred to other providers. Only 11 referrals were received during the trial that did were not directly from the screening process. Only one woman required transfer to hospital following serious self-harm and there were no suicides.

The project also helped to enhance the skills of correction staff in identifying and managing inmates with mental illness.
Contact: Dr Mark Earthrowl 03 3391148
email: mark.earthrowl@cdhb.govt.nz

West Coast
Spring into Action – move your way to better health
More than 400 competitors in 50 teams walked, gardened and line danced their way through the first West Coast-wide Spring into Action ‘get up and get moving’ campaign.

This West Coast District Health Board initiative to promote exercise as an everyday activity was a huge success with businesses, schools and councils taking up the challenge.

The DHB’s to the Coast’s businesses was that the health benefits of exercise are mental as well as physical. A fit and active workforce is more productive, with greater output and less absenteeism.

While many fitness initiatives have focused on walking, running or cycling, Spring into Action was about simply getting moving. Housework, gardening and any form of exercise that increases the heart rate counted.

People attracted to the six-week challenge at the start of 2005 included staff from New World supermarkets, primary school teachers and pupils and district council staff.

Larger organisations were encouraged to split into teams and compete against each other. Teams had four to 10 members who earned points through the amount of exercise they did. More exercise equalled more points earned.

Spring into Action proved to participants that exercise was not daunting but something that could be added to their everyday lives simply and effectively.

Plans are underway to make it a regular event.
Contact: Vikki Carter 03 768 0499
email: vikki.carter@westcoastdhb.org.nz

PrISM - Primary integration systems management - overcoming isolation through innovation.
Patients on the isolated West Coast are enjoying better health care thanks to a new computer system that provides primary health services with fast and reliable access to patient information.

The West Coast DHB-designed PrISM system provides health professionals with access to email and electronic health information through a secure communications network. Any site that operates the system can access patient information, regardless of where the patient goes for treatment.

Health professionals are fully informed about a patient's clinical history when a consultation occurs, improving patient safety. PrISM also eliminates the risks of errors due to the misinterpretation of hand written medical notes.

Health professionals on the PrISM network will eventually have better access to electronic health information than most primary heath providers. Laboratory tests are already being sent to the PrISM network every 10 minutes, whereas most primary practices receive electronic laboratory results three times a day.

The aim is to computerise the paper-based information that follows patients from a GP referral, into an outpatient clinic, then into hospital and then back again when the patient is discharged.

PrISM is operating in South Westland, Greymouth, the Grey Valley and the Buller District. The West Coast DHB intends to make the system available to all independent primary health practices on the West Coast, so that the system becomes a completely integrated, region wide electronic patient record.
Contact: Wayne Champion 03 768 0499
email: wayne.champion@westcoastdhb.or.nz

Dunedin
Integrated medical centre
A software tool to assist GP practices and primary care services to integrate in a ‘one-stop shop’ aims to provide better health care for Otago patients and improved working conditions for clinicians.

The software, called the Integrated Medical Centre, provides an opportunity for primary health care organisations and GP practices to bring together existing services such as specialist nursing services, pharmacists, physiotherapists, occupational therapists and others.

Otago DHB says providers benefit from shared administration and cut down on overheads and common space requirements such as waiting rooms and car parking.

Large centres can roster more efficiently, improving access through extended hours of business and improving lifestyle options for staff through more flexible work routines.

It is envisaged that one-stop-shops could also introduce new services and support initiatives such as a nurse telephone triage service, nurse led clinics, and working with the community to promote wellness and undertake screening programmes.

The Integrated Medical Centre has been developed jointly by Otago DHB and Auckland based LifeCare Solutions Ltd. Two rural areas are currently developing new integrated centres using Integrated Medical Centre.

Otago DHB will be offering the use of Integrated Medical Centre to any interested primary health organisations or primary care practices in Otago, and it will be available nationally through LifeCare Solutions Ltd.
Contact: Ants Howie 03 4703809
email: anthonyh@healthotago.co.nz

Southland
Connecting people - a videoconferencing model for rural health centres
Access to broadband means better care for patients in Southland.

Southland has the second largest geographical spread of all DHBs in New Zealand. Specialist medical practitioners are isolated from their peers and clinical supervision requires more than a telephone call.

Being able to access internet based videoconferencing has proved cost effective and will bring huge benefits to staff in their care and support for patients.

Old telephone line-based connections have until recently limited Southland’s capability for videoconferencing. The new system operates through an internet provider joined up to the NZ Telepaediatric Services' existing 18-unit national videoconferencing network.

The videoconferencing facility provides increased access to clinical skills not on site. It can be used for patient reviews linking Auckland's Starship children's hospital with the intensive care unit at Southland to determine if a transfer is required. Interpreter services not available in the region can be accessed and the system can provide peer review for sole practitioners in alcohol and addiction services or other specialist hospital services.

Videoconferencing improves accessibility and lowers costs by reducing travel costs to national meetings. It allows Southland Hospital anaesthetists to connect with colleagues in Melbourne for training and case reviews. Human resources can use videoconferencing for overseas recruitment. Rural medical centres are less isolated, with Te Anau and Lumsden medical centres included in the upgrade.

ENDS

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