The cost of major head and neck cancer surgery
The cost of major head and neck cancer surgery is unknown. In this study, 245 patients underwent major head and neck cancer surgery over a five-year period at the cost of NZ$5,130,639.00, averaging NZ$20,941.38 per patient. There are many different types of head and neck cancers. The cost of treatment varies depending on the type of cancer. Calculated hospital income merely covered the actual cost of major HNC surgery, which places substantial financial burden on the hospital.
Enhanced hip fracture management: use of statistical methods and dataset to evaluate a fractured neck of femur fast track pathway—pilot study
This paper demonstrates how integration of service components that are involved in frac-tured neck of femur can be achieved. It also shows how the use of electronic data capture and analysis can give a very quick and easily interpretable data trend that will enable change in practise. Cooperation between health professionals and practitioners can signifi-cantly improve the length of stay and the time in which patients can be returned home. Full interdisciplinary involvement was the key to this approach. The use of electronic data capture and analysis can be used in many other health pathways within the health system.
Increased use of police and health-related services among those with heavy drinkers in their lives in New Zealand
The findings of this study are the first to show the extent of service use because of others’ drinking among the general population in New Zealand. There are considerable numbers of New Zealanders requiring intervention from police or health-related services due to the effects of someone else’s drinking. Heavy drinkers place increased burden on police and health-related services, not only because of directly attributable effects but because they impact others.
Implementation and effects of Enhanced Recovery After Surgery for hip and knee replacements and fractured neck of femur in New Zealand orthopaedic services
Eighteen district health boards (DHB) have introduced Enhanced Recovery After Surgery (ERAS), a new way of caring for people who need a hip or knee joint replacement or who have a fractured neck of femur (hip). ERAS is a patient-centred care pathway that aims to ensure people are in the best possible condition for surgery, have the best possible management during and after their operation and participate in the best possible rehabilitation after surgery. The National Orthopaedic ERAS Collaborative used collaborative quality improvement methodology to implement ERAS in the DHBs. Compliance with the elements that make up ERAS increased from 33% to 75% for knee replacements, from 31% to 78% for hip replacements and from 29% to 51% for fractured neck of femur. The length of time patients spent in hospital for knee joint replacement fell from 5.4 days to 4.5 days, and for hip replacement from 5.1 days to 4.3 days. ERAS is known to significantly improve surgical outcomes for patients and the cost-effectiveness of care. It has also been found to reduce the surgical death rate.
Effect of the Shorter Stays in Emergency Departments time target policy on key indicators of quality of care
This study explored the association between the introduction of a mandatory national target for emergency department (ED) length of stay, which was introduced in New Zealand in 2009, and five key indicators of quality of care. We did this study as there is some evidence from overseas that focusing on a process target for the time spent in the ED may divert attention away from other aspects of quality of care. Our study found that more people left the ED within six hours after introduction of the shorter stays in ED target. There was no difference in the quality of care for patients in pain, with severe infections, with heart attacks, with appendicitis and with fractured hips when comparing the outcomes for these conditions before and after the introduction of the target.
Survival of Legionella in earthquake-induced soil disturbance (liquefaction) in residential areas, Christchurch, New Zealand: implications for disease
Legionella bacteria is ubiquitous in the environment. This study set out to expand our understanding of the environmental exposure risks to Legionella and whether seemingly unrelated environmental factors, such as aerosolised liquefaction-affected soil resulting from the Christchurch earthquakes had the potential to impact on disease prevalence. Liquefaction-affected soil could not contribute directly to the observed increase in legionellosis cases after the earthquakes due to its inability to support growth and survival of the Legionella bacteria. Chemical and size analysis of the liquefaction-affected soil showed it consisted of >65%. Silica. The authors propose that inhalation of earthquake associated airborne liquefaction-affected soil can damage lung tissue and cause inflammation. Inflammation and damage could allow opportunistic pathogens, such as Legionella bacteria, to more successfully infect the human host.
A walking stick in one hand and a chainsaw in the other: patients’ perspectives of living with multimorbidity
Living with multimorbidity (two or more long-term health conditions) is becoming more common in both young and older New Zealanders. It disrupts people’s 'normal' lives, posing challenges for many, yet people learn to cope by making changes to much of what they do (eg, eating, activity and employment). Dealing with the health care system for those with multimorbidity can be challenging and people value simple things like good communication and receiving care that is effective and respectful even when they are from a different cultural background to that of their health care provider. Health care system support is needed to help people with multimorbidity manage the challenge of dealing with multiple medications using simple aids such as blister packs. Improvements to the health care system are needed to better serve those people living with multimorbidity, their support people and health care providers, eg, longer consultation times with GP/primary care providers to discuss multiple health issues and medications.
Impact of a national time target for ED length of stay on patient outcomes
The Shorter Stays in ED target was introduced to reduce ED crowding, which is known to have adverse effects on patient care. Although similar targets introduced overseas have not always resulted in the improved quality of care, this study shows that in New Zealand, people waited less time in the ED before they were admitted to hospital after the target. This was associated with a substantial reduction in ED crowding and a reduction in the number of deaths in the ED compared to what was predicted if pre-target trends had continued. Fewer people left the ED before their care was complete and admission rates to hospital did not change substantially. Overall, people spent an average of seven hours less in hospital after they were admitted to a ward, but there was a small (1%) increase in the number of readmissions to hospital at 30 days after the target.
New Zealand plastic surgeons’ life-time contribution to peer-reviewed literature
The New Zealand Medical Association commits the New Zealand doctor to evidence-based medicine, scholarship, teaching, collaboration and communication. To assess this commitment, one measure, contribution to the peer-reviewed literature, was examined for one group of New Zealand doctors: plastic surgeons. Based on this metric, as a group, but with exceptions and less so in later practice, New Zealand plastic surgeons would seem to demonstrate this commitment.
Rotorua, hydrogen sulphide and Parkinson’s disease—A possible beneficial link?
Rotorua city (New Zealand) is known for its ‘rotten egg’ smell, due to high levels of hydrogen sulphide (H2S) concentrations emitted from local geothermal vents. Studies have shown H2S as potentially toxic if too high in concentration. However, research on H2S on health postulates whether ambient air inhalation levels of H2S in Rotorua might have a therapeutic role in the management of motor symptoms in Parkinson’s disease (PD). An observed beneficial link between chronic H2S inhalation in PD animal models and improved finger tapping scores in a sample of the Rotorua population, linked to dopaminergic nerve function, is worth investigating further.
Is high-quality trauma care “business as usual” in New Zealand?
New Zealand is on the cusp of establishing a world-class trauma system. Many of the building blocks are in place with national and regional guidelines in both the pre-hospital and hospital phases of care established. A dedicated clinical workforce is available in all DHBs and national data is available through the Major Trauma Registry. The greatest threat to achieving high-quality trauma care in New Zealand at this point is governance stability rather than clinical variability. Now is the time to lock the trauma system into a framework not subject to political or bureaucratic whims.