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A project investigating communication between Dunedin Public Hospital Staff and General Practitioners from the perspective of the hospital clinical staff

Abstract

Introduction

In December 1995 a Trainee Intern Healthcare Evaluation Project entitled “Splendid Isolation” looked at communication issues at the interface between primary and secondary health care by surveying GPs in the Otago area.  This Trainee Intern Healthcare Evaluation Project was commissioned to look at communication issues from the perspective of Dunedin Public Hospital (DPH) clinical staff.

Aims

The first of our general objectives was to identify strengths and weaknesses of communication between GPs and Healthcare Otago clinical staff.  The second was to identify barriers to communication and to make recommendations on how these might be removed.

Method

A questionnaire was designed to meet the study’s aims and a sample of DPH consultants and registrars were selected to participate in the study.  All “heads of department” were included, and a sample of the remaining clinical staff were randomly chosen to give a sample size of 117.

Results

The overwhelming majority of doctors rated the quality of communication as either good or adequate.  However, 54% thought that better communication would always or often improve patient outcome.  Problem areas identified with current referrals from GPs included allergies, social history, what the patient has been told and what the patient expects from the referral.  Opinion was divided as to whether a standard referral form would improve communication, with A&E and peadiatric departments being the most strongly in favour.  67% thought that GPs should always or often be informed within 24 hours if one of their patients was admitted acutely.  Delays in sending discharge letters was identified as a problem area.  77% of hospital clinicians felt that there were barriers to communication between themselves and GPs.  Specifically typists, internal hospital mail, inadequate staffing levels and lack of time were identified by a number of doctors.  Common suggestions for improving the current situation included the need for more staff in many areas and the increased use of automation and communication technology such as facsimile and computer linkages.

Conclusion

A number of recommendations for improving communication between Otago GPs and DPH clinicians were put forward.  Similar to the “Splendid Isolation” study in 1995, we found that many of the perceived barriers to communication lay within the clerical and mailing systems of the hospital.  An investigation to identify the exact problems was proposed.  The future of communication seems to lie with the increased use of automation using various media including facsimile and email.  Improving the availability and usage of electronic communications was suggested.

Authors of Report

Deborah Jessup, Chhay Ly, Ben Beaglehole, Anna Winter, Graham Wesley, Honathan Kennedy, Eta Raicebe, Janet Gentry

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Childhood Drowing

Towards the development of a Child Safety Index for communities in New Zealand
Part I: a pilot survey on education in swimming and water safety in Dunedin Schools

Introduction

Every year, approximately 880 NZ children between the ages of 0-14 years die from all causes.  Seventeen percent of these are attributable to injury.  By proportion, injuries figure more prominently after the first year of life and account for almost half of the heaths in children.  As a cause of injury, drowning (+) claims about 30 deaths per year (18% of all injuries).  Between 1980 and 1994, there were 436 childhood drowning.  By international standards this is high, with a drowning rate in New Zealand of about 5 per 10,000 0-14 year olds, when compared to rate in Australia (3.5/10,000_, the UK and the USA (both about 3/100,000).  (1), (2)

It is important to bear in mind that he mortality data presented here only represents the tip of the iceberg.  Indeed, drowning is only one end of the continuum of water accidents.  The frequency of potential drowning accidents (defined as a situation where the child was found by chance in water, and would have drowned if it were not for the chance finding) has been report in two NZ studies.  (3), (4) One found that 9% of a large sample of 1-3 year olds had experienced a potential drowning accident and, of these, 10% received some sort of medical attention (30% active resuscitation, 40% A&E, and 30% GP). (3)  The other reported a similar rate of 8.5%. (4)  In a two year period (1987-8), 137 children (0-14 years) were admitted to NZ hospital because of immersion accidents, a figure twice that of the annual mortality for drowning. (2)  Furthermore, serious immersions constitute a source of considerable morbidity, in the form of permanentneurological sequelae, and cost to hospitals.  A study of the outomces of 146 chidlren in the british Isles who were victims of serious immersion incidents (lost consciousness in the water), showed that 11% subsequently died and 7% were left severely handicapped. (5) cited in (2)

Authors of Report

Sarah Abrahamson, Paul Blundell, Mike Haymes, Selena Hunter, Jarrod Ngan, David Whitley

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Client satisfaction with the National Poisons Information Service

Abstract

Introduction

The National Poisons and Hazardous Chemical Information Centre (NPHCIC) in Dunedin, NZ, offers 24-hour telephone information/advice regarding a number of services related to poisons and hazardous chemicals.  The service currently operates under a local Dunedin number (ie. toll call from outside Dunedin area).  The centre receives approximately 20,000 calls annually with approximately equal numbers from health professionals and the general population.  Review of the international literature shows that poisons centres are beneficial both in terms of health and cost effectiveness.

Aim

To carry out a survey of the users of the NPHCIC in order to assess public awareness of, and satisfaction with the service, and public opinion rearding costs and funding of the centre.

Methods

A random, stratified, cross sectional telephone survey, (n = 433, response rate = 79%) of callers to NPHCIC during the period 1 July 1996 to 30 June 1997 (pop. = 20,207) conducted during a two week period in July 1997 using a 20 item questionnaire.

Results

Most frequent callers to NPHCIC were aged 25-44 (77%), female (79%), European (94%).  Callers reported a high level of satisfaction with the service.  There was a low perceived level of public awareness among callers.  Callers were in favour of a Government sponsored toll-free number to NPHCIC although the current local Dunedin number was not perceived as a barrier to calling.

Conclusion

Caller satisfaction with the NPHCIC’s telephone service is high however levels of public awareness are sub-optimal and the service is underutilized by non-European ethnic groups.  A toll free (0800) number would have benefits in increasing accessibility to the service for all sectors of the population.

Authors of Report

Scott Cameron, Bernard Cheu, Jo Green, Chris Nicholson, Kylie Smith, Viktoria Sundakov, Allan Tee, Stuart Tie

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Do patients’ perceptions of issues affecting their wellbeing agree wit those of their attending doctors?

Abstract

Aim

To determine whether patients’ perceptions of factors affecting wellbeing agree with those of their attending doctors.

Design

Self administered questionnaires were constructed in two sections.  The first was an open ended ‘problem list’ asking patients to list all factors affecting wellbeing while section two consisted of 23 structured questions from five domains.   A similar questionnaire was designed for doctors regarding their patient’s wellbeing.

Subjects

A random sample of 36 medical inpatients at Dunedin Public Hospital and Wakari Hospital was recruited over a two week period.  The questionnaire was administered to these patients and their attending doctor.

Outcome Measures

Standard demographic data was collected.  Matched doctor-patient data pairs were analysed with a stem leaf plot in the problem list section and the weighted Kappa as measure of agreement in section two data.

Result

Most problems identified by patients were in the physical domain.  In two thirds of doctor responses 50% or more of these were identified.  Doctors identified 7 of patients’ 22 problems and 3 of 19 problems which fell in the social and psychological domains respectively.

Conclusion

This study shows that doctors are not identifying some problems that their patients perceive.  Increased effort in identifying patient problems while on the wards would be most beneficial if targeted at not only physical issues but also psychological and social concerns.

Authors of Report

Nizar Abdul Manap, Sally Barlow, Afidah Karim, Heidi Oettle, Scott Barker, Chris Harrington, Oleg Kiriaev

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Measures to control the 1997 measles epidemic:  Do they make sense to parents?

Aims:

  1. To estimate current levels of knowledge of parents of children aged 2 to 10 years about measles, measles immunization, and the proposed intensified measles immunization strategy.
  2. To determine how acceptable the proposed intensified measles immunization strategy is to those parents.
  3. To determine the information needs for parents in deciding to accept the offer of an early second dose of MMR.
  4. To determine parents preferences for the setting within which immunization of children aged 2 to 10- years would take place.

Authors of Report

Nat Anglem, Jenny Ho, Azhana Mohamad, Gerardine O’Kelly, John Robson, Richard Shepherd, Jeanne Tie, Kang Wei Ta

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Temporomandibular joint disorders – do we need fancy technology?

Abstract

Temporomandibular joint (TMJ) disorders are a constellation of symptoms including click, lock or pain in the TMJ joint, headache, earache, tinnitus and myofacial pain.  The disorder is very common, with up to 28 percent of the population being affected at some time.  Diagnosis is essentially clinical, based on a history of troublesome symptoms, and the presence of tenderness, crepitus or lock on the examination.  Various imaging techniques can be used to confirm the diagnosis, and exclude other pathology.  These imagining  techniques include the use of plain radiographs, tomography, computerized tomography (CT), bone scan and magnetic resonance imaging (MRI).  Treatment approaches are varied, but usually consist of a trial of conservative methods (reassurance, soft diet, and physiotherapy), followed by the use of medical and dental approaches (bite splints, NSAIDs and other drugs), and in severe cases, surgery (arthrocentesis, arthroscopy or arthroplasty).

The University of Otago Dental School as a clinic dedicated to the management of patients with TMJ disorders.  Over the last seven years, many of these patients have undergone radiographic investigations including bone scans, MRI and arthrography.

The aims of this study were to explore the correlation between clinical and radiographic findings in patients with TMJ disorders who have received bone schans or MRI, and to assess the extent to which radiographic investigations influence the management of patients with TMJ disorders.

We conducted a clinical audit of patients at the TMJ clinic who had undergone either MRI or bone scan.

The demographic data showed an age/sex distribution as expected with a predominantly female (85%) sample population (figure 1 and 2).  This showed a right skewed distribution with usual age of first onset at age 10-39.  Most people presented in the first year following onset of symptoms.

Most of the patients in our sample (>80%) presented with pain in the TMJ joint or facial pain in the mandibular area.  Other common presentations were a click, crepitus, locked jaw, ear symptoms and neck pain.

On examination, most patients have tenderness to palpation in the muscle or joint of the mandible (>70%) and many have a click or crepitus (>50%).

These results suggest that there is little correlation between the results of various modes of imaging, nor between imaging results and clinical signs and symptoms.  Furthermore, advanced radiological imaging does not appear to have any clear effect on management or outcome.

Thus, the results of this preliminary, descriptive study challenge the usefulness of advised imaging techniques in the diagnosis and treatment of TMJ syndrome.

Authors of Report

Tracey Fay, Dean Frear, Adrian Gilliland, Anne McGregor, Robert Park, Marie van Wyk

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What could a community oriented medical school in Otago be like?

Abstract

Recently in Dunedin there has been a lot of interest in the idea of making medical schools more responsive to the health needs of the communities in which they are located.  This concept has come to be covered by the general heading of “community oriented medical education” Future developments for Dunedin School of Medicine are currently being explored by senior academic staff.

Our group reviewed the experience of community oriented medical education programmes overseas.  Knowledge and attitudes of teaching staff at the Dunedin School of Medicine was assessed.  Within the medical school two groups were identified.  Firstly, we interviewed members of the Future Options Working Group.  Information form these interviews was used to construct a closed option questionnaire which was administered to a representative sample of 40 clinical teachers.

90% of clinicians are aware of moves to create a community oriented medical school in Otago.  Attitude towards this is of guarded approval.  Most saw teaching taking place in a variety of locations but believed Dunedin Public Hospital should remain the base for most clinical training.

Finally, recommendations based on the literature review and the two surveys are made.

Authors of Report

Judith Cubitt, Kumudith Ekanayake, Shalini Karan, James Macdonald, Dick Ongley, Rohit Santram, Nina Stupples, Jennifer Wong

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