Health Targets - Quarter 1 results

We have the six-hour target in our sight

A stay of less than six hours for 95 per cent of our patients in Waikato and Thames hospitals’ emergency departments is our target. While Thames is nearly there – hovering around the 90-92 per cent mark – Waikato Hospital has some way to go. The department currently sees an average of 150 patients each day. From July through to September this year, we treated, discharged or admitted 65.34 per cent of our 14,028 patients within six hours.

What are the six Health Targets?How are we doing?

Time trackers: Waikato Hospital group manager Dr Grant Howard and Emergency Department operations manager Jenni Yeates in front of the six-hour target screen now in place to help Waikato monitor progress and meet its 95 per cent health target.

We have done better since then – now up to 74 per cent - but we still have a long way to go to achieve the 95 per cent target by 30 June next year.

It is clear that we need a staged and sustainable approach involving a whole of hospital response.

We now have a real time report running in the department, with six-hour target screens constantly updating. These raise the profile of the target and spark conversation and actions among staff.

This is what we do know about Waikato Hospital’s emergency department:

• Presentations are increasing at a rate of more than two per cent a year, which is ahead of population growth and reflects what’s happening nationally and internationally.
  
  
• Patients have more complex needs with higher growth in triage one and two (seriously ill), minimal growth in triage three and not a lot of movement in triage four and five.
  
  
• The vast majority of patients present because they believe it is the best place to be.
  
  
• The presentation rate and the census of the department follow a very predictable pattern.
  
  
• The ratio between self-presenters and those referred by their GP, medical centre or emergency services is 53 per cent to 47 per cent.
  
  
• That 60 per cent of our patients are under 45 years old.
  

Think of the hospital as a continuous stream - there is more than one department involved in a patient’s journey. If someone down the line is not doing his or her bit to contribute then the work clogs at the start - in emergency.

Alternatively, think of a patient’s journey through our hospital as a busy road. Too much braking, slow driving and people stopping for even just a few seconds creates a ripple effect that moves backwards through traffic, grinding everything to a halt for kilometres.

Emergency departments provide acute health care so the timeliness of treatment delivery (and any time spent waiting) is important for patients.

Long stays and overcrowding in the Emergency Department can obviously affect patients and the speed with which they get care and start the process of healing. Neither is it a good and safe environment for our staff to work in.

Waikato Hospital is a big place and a complex system, to improve, and to eliminate waste takes time if it is to be done well. 

While not all change is improvement, we cannot expect improvement if we do not change what we are doing.

Everyone who works at Waikato Hospital – from doctors and nurses, to attendants, cleaners, administration staff and duty managers – all play a part in achieving this 95 per cent target. Emergency Department staff cannot do it by themselves. We accept the six-hour target is a good thing so long as the focus remains on the patient, and you have our commitment that it will.

Outstanding surgery results for Waikato

Waikato DHB improved access to elective surgery in quarter one achieving a result of 113 per cent.

We are justifiably proud of the improvement in the amount of elective surgery we performed in the last year.

We made more use of the private sector on our behalf and the effort and thought put in by all involved staff was impressive.

But that’s only half the story.

There will no doubt be many people who are still waiting for surgery who read these results and find them cold comfort. We hear from them often, and we also hear that the public system is not coping, and that “going private” is the only option if you want what you need, right now. We are listening.

Waikato Hospital is committed to providing a level and quality of service we can all be proud of and which meets the essential demands of the area.
A service we can trust ourselves and our family to.

Recently the mother of a 21-year-old told us how her GP said Waikato Hospital had long waiting lists for surgeries.

Her son needed a benign tumour removed which would cost her $3000-$4000 in a private facility.

Within three months he had completed all his clinic appointments and had day surgery at Waikato Hospital in the public sector where one of the country’s top plastic surgeons removed his tumour.

So while we are entitled to feel good about our performance, we do so with a sense of determination that we can do better.

Immunisation target hits the road

The target That 85 per cent of two-year-olds are fully immunised by July 2010; 90 per cent by July 2011; and 95 per cent by July 2012. What is Waikato doing to achieve it? In addition to the everyday immunisation work carried out for children, Population Health also as an Opportunistic Immunisation Service operating at Waikato Hospital and a Mobile Immunisation Service travelling out in the community. Both of these services focus on accessing hard-to-reach children and reducing the barriers to accessing health care services such as immunisation, by taking the service to the family. Waikato’s Mobile Immunisation Service started last year with two teams each comprising a community nurse vaccinator and a community support worker. They use a purpose-built van to travel the region immunising children referred to the service by their general practice.  If the teams miss a family at home, they leave a calling card with a free call number to reschedule an appointment. More than 70 per cent of all call back cards resulted in follow-up contact by the family.

The teams access the National Immunisation Register remotely to check a child’s immunisation status, providing a high opportunistic immunisation uptake rate.   

Between November 2008 and June 2009, the Mobile Immunisation Service delivered 1100 immunisations to under six-year-olds in their homes or on the mobile immunisation van.

The team delivers 190 child immunisations per month. All clients have their immunisation status updated and notified to the GP within 48 hours of delivery.

Waiting times for cancer treatment

Health Waikato has a number of initiatives to improve the quality and timeliness of service delivery for patients with cancer, including: The purchase of onboard imaging equipment to reduce the risk of exposure of a patient’s internal organs to radiation. Developing short information videos available on DVD and the Waikato DHB website to familiarise people with treatment procedures they may experience before coming in for treatment. Ongoing development within the service to make it attractive to potential candidates and assist in recruiting.

Better help for smokers to quit

A second registered nurse now works for Waikato DHB to help its existing Smokefree clinical nurse coordinator achieve the health target: ‘better help for smokers to quit’. The Smokefree registered nurses completed baseline audits in all the affected hospital areas to find out which areas are performing and which are not. They are now working closely with those areas that need to improve to find out why and how they can help Waikato DHB  achieve this target. More than 600 staff have been upskilled about smoking cessation as part of this process.

Diabetes and cardiovascular services

Good results require doctors and nurses to reach an increased proportion of people at risk of diabetes and cardiovascular disease and then provide good quality follow-up. 

The best performing DHBs, like Waikato, appear to have good quality primary care and good integration between primary care and hospital-based diabetes services. Diabetes management is one of the most challenging indicators of quality of care for people with diabetes.

The top DHBs in this period are doing very well by any international standard, and the remaining DHBs need to work with PHOs and other diabetes services to improve their results.