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Dunedin Hospital … Are we admitting appropriately

Abstract

The group carried out a retrospective application of the Admission Evaluation Protocol (AEP) criteria to 100 acute admissions in the areas of Medicine, Surgery and Paediatrics.  Rates of inappropriate admissions were 6%, 9% and 8% respectively.  Review was carried out by two people in each area, correlation between whom was checked and found satisfactory.  There were few significant correlations between data collected on the cases except that:

  1. In medicine there was a higher rate of inappropriate admissions when there were 3 or more beds available and where the disorder was respiratory.
  2. In surgery Consultants admitted inappropriately more often than Registrars and House Surgeons.
  3. In paediatrics the rate of inappropriate admissions was higher amongst females.
  4. There was a high level of readmission to the medical service for the same problem within a month of discharge.

Overall Dunedin’s rate of inappropriate admissions compares with similar hospitals in the US, Canada and Australia.  A recent study of a NZ provincial hospital (from which this followed) showed a much higher rate of inappropriate admissions.  This may reflect the higher level of expertise and experience amongst admitting staff in Dunedin coupled with access to more sophisticated investigations on an urgent basis.  Further study of discharges would be of interest to gauge the level of “inappropriate discharges” from Dunedin.

Authors of Report

Latham Berry, Nicola Dalbeth, Shailesh Dass, Matt Holton, Jane Howe, Nabura I’oteba, Susannah Lewis, Kim Naylor.

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Health information privacy code (H.I.P.C)

Aim:

The aim of this study included:

  1. Assess the knowledge of, and the attitudes toward the HIPC of health professionals.
  2. How they feel it has affected their practices and their patients.
  3. Access the attitude towards the HIPC of health professionals.
  4. Observe differences in the above between health professional groups (Consultants, Registrars, House Surgeons, GPs’ Senior Nursing staff)

Authors of Report

Stuart L Jones, Anthony McNaughton, David A Paul-Jama, Vernon Reynolds, Warren J Simpson, Jeremy G Whiting.

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Hospital admission criteria.  Application to a New Zealand Hospital

Introduction

Tairawhiti Healthcare Ltd provides a range of service to the people of the East Coast of the North Island.  They are funded for these services by the Midland Regional health Aurhotiy (RHA). Tairawhiti Healthcare Ltd is a Crown Health Enterprise (CHE), its principal hospital is Gisborne Hospital, with 11,881 admissions in.  In order to ensure that the activities of the CHE are appropriate, the RHA is seeking to develop objective criteria against which various activities can be measured.  With respect to inpatient admissions to Gisborne Hospital the RHA has signaled its intention to work with the CHE to develop an agreed set of admission criteria.

In preparation for this task, Tairawhiti would like to be better informed in three areas.  Firstly, what admission criteria have already been developed?  Secondly, what has ben the experience of other hospitals in the use of admission criteria?  Thirdly, to what degree is this experience applicable to Tairawhiti.

Authors of Report

Chris Birks, Rupa Maitra, Graeme Roadley, Tralee Sugrue, Qalo Sukabula.

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Monitoring of the Vaccine Cold Chain in Dunedin General Practices

Abstract

A well maintained vaccine cold chain is vital in an immunisation programme.  Disruption of the cold chain may occur at many levels.  This can lead to low potency vaccines and outbreaks of serious vaccine-preventable diseases.

Guidelines for storage and handling of vaccines have been recommended by the CDNZ after a national study discovered some problems in the cold chain at the end-user level.

The aim of this study was to investigate the current vaccine storage and handling procedures within the Dunedin area, and to determine whether further recommendations were required to improve the vaccine cold chain.

All the General Practices in the Dunedin area which used childhood vaccines agreed to participate in the study.  The person primarily responsible for vaccine storage and handling was interviewed.  The refrigerators were inspected and maximum and minimum temperatures were recorded.

We found that 37% of the practices did not follow any specific guidelines for vaccine handling.  No practice followed the CDNZ recommendations accurately and only 41% had refrigerators that were within the suggested temperature range.

Our results suggest that failure of the vaccine cold chain may be an important factor in the outbreak of vaccine preventable diseases.

A modified list of guidelines for vaccine storage and handling was developed and sent with feedback to all General Practices.

Authors of Report

Barabara Adams, Rosemary Hall, Stephen Inns, John Schollum, Martin Stiles, Victoria Stott, Lynda Thwaites, Henry Young.

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Needlestick Injuries in the Surgical Division

Abstract

We undertook this survey as our final year Community Health Evaluation Project.  The aim of the survey was to evaluate the knowledge, practice and attitudes of the staff in the surgical division towards needlestick injuries and blood borne diseases.  This was accomplished by means of an anonymous self addressed questionnaire sent to every member of the Dunedin Hospital surgical division.  The response rate was 60% and was evenly distributed.  It was found that there was a high rate (33%) of non-reporting of needlestick injuries.  Consultant/registrars had a high risk of injury and a low rate of reporting compared with other groups.  This group also had relatively low rate of use of safety measures.

The most common reasons for failing to report an injury were “reporting is a hassle” and “patient was in a low risk group”.  Eighty one percent of staff were immunised against hepatitis B, fewer having checked their serological status in the last five years.  Knowledge concerning the risk of transmission via needlestick of HIV, hepatitis B and C was poor and respondents tended to under-estimate the risk.  Despite having an official “recapping with needleblock” policy at Dunedin Hospital many respondents complained about the lack of availability of needleblocks and 25% of injuries occurred during recapping.

Recommendations to improve staff safety include:

  • Review recapping policy and improve the availability of needleblocks if it is to be retained.
  • Targeting of the registrar/consultant group with regard to reporting injuries and safety measures.
  • Streamlining the reporting process
  • Instituting a hepatitis B vaccination drive and checks of serological status especially among ward nurses.
  • Improve the knowledge of needlestick transmission of blood borne diseases among staff.

Authors of Report

Tony Diprose, Owen Doran, Steven Fowler, Jeremy Hay, Philip Haywood, David Longston, Ywain Lawrey.

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Nosocomial Septicaemia Dunedin Public Hospitals 1994 A descriptive study

Introduction

Nosocomial septicaemias present a major problem in hospitalized patients.  These potentially preventable infections have considerable medical, financial, ethical, social and legal implications.  Estimation of nosocomial infections in hopitalised patients vary from 3% to more than 10%, of which septicaemias account for approximately 5% of the total.1

This study set out to provide a descriptive analysis Nosocomial septicaemias that occurred in Dunedin or Wakari hospitals in the year 1994.  Previous data collection on Nosocomial septicaemias at Dunedin Hospital was limited.  As such it did not provide data which could form a basis for identifying possible problem areas or the extent to which Nosocomial septicaemias affect patient outcome.

The data provided by this sty being descriptive in nature is hoped to be hypothesis generating for further studies with regard to Nosocomial septicaemias.

Andrew Jackson, Gaurav Deva

Authors of Report

Andrew Jackson, Gaurav Deva.

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Planning for a critical pathway – an audit of drug use during coronary artery bypass graft surgery

A common planning challenge for contemporary health systems – whether at the national, local, or institutional level – is the optimizations of care provision within fixed or available funding and budgetary constraints.  Meeting such a challenge is now shared between both clinicians at the coalface and also health planners and administrators.  With the current emphasis on reform, and the seeming need for further refinements in high quality outcome and efficiency, the required planning has demanded the development of new health care planning tools and techniques.

One such tool is the Critical Pathway Method (CPM) which is currently under investigation by the Quality Assurance Group at Dunedin Hospital with a view to introduction on site.  The critical pathway method develops an ideal plan of care for patients from preadmission to discharge.  Critical paths are developed for each specific patient populations which can be defined by diagnosis (eg. Myocardial infarction), procedure (eg. coronary artery bypass graft, total hip replacement) or condition (eg. failure to wean from ventilator, cardio-pulmonary arrest).  Each of these critical pathways will aim to incorporate and address the usual patient problems, and the desired clinical outcomes which might then incorporate several intermediate goals within a framework of optimal sequencing and timing.

The Quality Assurance Group has chosen patient undergoing coronary artery bypass graft (CABG) surgery as the first patient population for which a critical path will be developed.  In the planning stage, all aspects of patients’ care and stay need to be detailed such as diagnosis, assessment, preoperative management, surgery, and postoperative care.  Drug utilization is one important aspect of the critical pathway for patients undergoing coronary artery bypass surgery in both clinical and fiscal terms.

As part of the planning stage for developing a critical pathway, an audit of drug charts of 223 patients undergoing coronary artery bypass graft surgery at Dunedin Hospital in the period from November 1993 to October 1994 was undertaken by a group of seven Trainee Interns from the Otago Medical School.  The aim was to identify the drugs and dosage regimens of coronary artery bypass graft surgery patients during the immediate postoperative period spend in the intensive care unit.  This was to be a preliminary step towards developing a critical pathway and in the development of quality assurance protocols.

Authors of Report

Vicki Cavanagh, Victor Chen, Gary Cheung, Marianne Elston, Suetonia Green, Maraekura Horsfall, Caroline Meade.

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Splendid Isolation.  A project investigating communication issues at the interface between primary and secondary health care in the Otago area.

Aim

The aims of the project was to analyse communication issues at the interface between primary and secondary healthcare in the Otago area.  This was to be assessed by ascertaining from GPs the difficulties that they encounter in communicating with the Dunedin Public Hospital, specifically with regards to:-

  1. communication with hospital doctors,
  2. access to patient information held by the hospital, and
  3. access to patients while they are inpatients.

Authors of Report

Rebecca de Souza, Joellene Mitchell, Anna Nicholson, Bridget Collins, Grant Hounsell, Hamish McCay.

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Who cares for the caregiver?  A needs assessment of those caring for people with Dementia

This project arose as a result from an approach from the Dunedin branch of the Alzheimer’s Dementia and Related Disorders Society (ADARDS).  Government strategic planning now supports the move from hospital-based to community-based care of people with chronic illness.  Funding for services for specific groups is partly based on the prevalence and incidence of a disease type (such as the dementias), and the perceived needs of those with the disease.  ADARDS seeks to information regarding the service needs of those caring for someone with dementia and the impact that being a caregiver has on the caregiver’s quality of life.  Also ADARDS sought information on GP referral patterns and knowledge of services available as GPs are considered central to community-based care.

Authors of Report

Maggie Maclean, Mark Winstanley, Samantha Lowndes, Sarah Wilson, Andrew Munro, Wiki Jenkins, Malama Tafuna'i.

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