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Review Of Cardio Thoracic Services

7 October 2008

Review Of Cardio Thoracic Services

Director-General of Health Stephen McKernan says a review of cardiac services at Capital and Coast DHB has criticised delays in the treatment of some patients waiting for surgery,

The Director-General sponsored review, carried out by cardiologists Associate Professor John Elliott and Dr Ian Crozier, suggests a number of system improvements to help prevent deaths from avoidable delays.

The report finds that eight people who died while waiting for heart surgery in 2006 and 2007 were subject to avoidable delays in their care and treatment.

?I extend my sympathy to the families who have been affected,? said Mr McKernan, ?and want to assure them that this review has been undertaken to make sure we learn from these incidents.?

Mr McKernan thanked the reviewers for their report into a complex area of health care. People with severe heart disease needing surgery are very sick. In many cases their risk of death remains high before, during and even after treatment.

A wide range of resources and services need to be coordinated to maximise the number of complicated cardiac operations, and in this case funding was not the immediate limiting factor.

"The reviewers looked at patient records and talked with clinicians. They found that the deaths of eight people who were waiting for cardiothoracic surgery were potentially preventable.

?One preventable death is one too many and we need to make sure we learn from these incidents, and apply those lessons to the way we run our hospitals and care for patients.

"The report highlights the particular circumstances which led to this situation. There was significant growth in the number of people being referred for tertiary-level heart surgery along with delays due largely to workforce and theatre/ICU capacity issues which resulted in people waiting longer than they should have.

?The Ministry was concerned about the DHB?s performance in elective services in 2006 when it raised the matter with the Board and management. For the last 18 months, we?ve been working very closely with the DHB and the performance of the cardiac unit at Capital Coast has improved significantly.

"The cardiac service today is performing markedly different from the period examined in the report,? Stephen McKernan said. ?There has been a significant reduction in waits for treatment, in the last 12 months.?

?We have a national framework for systematically reporting and investigating cases where patients are harmed in incidents that are potentially preventable. The Ministry will be working with the Quality Improvement Committee, which leads this work, to advise how cardiac patient deaths are investigated, reviewed and acted on.?

The Ministry of Health is also involved with the Cardiac Surgery Service Development Group?s report which looks at the national picture and makes a number of recommendations including increasing the amount of heart surgery provided in New Zealand and focusing on developing the specialised workforce required.

Government announced today a $50 million investment in cardiac surgery over four years to lift New Zealand's cardiac surgery rate by a fifth.


Who commissioned the report?

The Director General of Health commissioned the review in February 2008 at the request of the Minister of Health following allegations of preventable deaths of central region patients waiting for cardio-thoracic surgery. Who wrote the report? The authors were recommended by the Cardiac Society. They are: John Elliot - a cardiologist and Associate Professor of Medicine at the University of Otago, Christchurch and Ian Crozier - Clinical Director of the Cardiology Department at Christchurch Hospital. What were the key findings?

The review noted that eight people who died while waiting for heart surgery experienced delays in the way their care was managed. Of these, three were waiting more than six months.

In total, the reviewers looked at the cases of 16 patients who died while waiting for cardiac surgery between 1/1/06 and 31/1/08.

The reviewers found that there were a number of factors ? there was significant growth in the number of people being referred for tertiary level heart surgery, and there were also delays due largely to workforce, theatre and intensive care capacity.

The reviewers note there has been a significant reduction in waits for treatment in the last 12 months.

What happens at other DHBs?

The situation at CCDHB was difficult during 2006 and 2007, and has been improving since then. Issues such as capacity constraints, workforce shortages and the need to appropriately prioritise patients will be impacting other cardiac centres in NZ to some degree. It should be noted however, that no other DHB had as great a proportion of patients waiting more than six months than CCDHB. Are cardiac patients safe to wait? The report notes that the public can have confidence in the clinicians involved in the cardiothoracic service and the standard of cardiac assessment and cardiac surgery.

The safety of cardiac surgery in New Zealand is relatively high by international comparisons. Unfortunately, the nature of the disease means seriously ill cardiac patients requiring surgery are at higher risk of dying before, during and after surgery.

In New Zealand over two thousand people had publicly funded cardiac surgery in 2007/08. Because of the serious nature of their illness it is estimated that between 4 and 6% would die in the first year following surgery.

The review states that no significant differences are evident between the Wellington and national one year post surgery mortality rates. What does the report recommend? Key findings include:

- planning for sustainable increases in the volume of cardiac surgery delivered by CCDHB

- ensuring that all medical and dental issues requiring clearance are completed in a timely fashion

- closer monitoring of patients on the surgical waiting list

- that waiting times and outcomes while waiting for cardiac surgery are subject to ongoing audit.

The reviewers note that CCDHB has already implemented many of the recommendations, and is making good progress on improving access to cardiac surgery.

At a national level, the reviewers recommend that:

- a national case based audit be conducted to assess waiting times and outcomes at all centres providing cardiac surgery in New Zealand

- a standardised booking system be used for cardiac surgery across New Zealand

- that national waiting times for cardiac surgery be monitored closely.

What has CCDHB done to reduce the backlog? Additional surgery was planned from 2006 onwards, followed by a comprehensive recovery plan requested by the Ministry in May and signed off in October 2007. There has been a marked improvement in performance this year.


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