Improving Electives Care Through Clinicians and
Managers Working Together
Equity of Access to High Quality Cardiac
Services for all New Zealanders
Leadership Group
 National Clinical Leader
 Regional Cardiac Networks (4) Clinical Leaders
 National Cardiac Surgery Network Clinical Leader
 Representative of the DHB CEO group
 Representative of the Director General
 Representative of the College of GPs
 National Heart Foundation Medical Director
 Cardiac Society New Zealand Chairman
 Director of Nursing Representative
Links
 The Cardiac Society and its subspeciality groups
 Australasian Society of Cardiac and Thoracic Surgeons








(ASCTS)
Health Workforce NZ
National Maori Cardiovascular Working Group
Diabetes Clinical Network
National Stroke Network
National Heart Foundation
National Health Committee
Primary Health Organisations
Others as appropriate
ACCESS
CONTINUOUS
IMPROVEMENT
QUALITY
EQUITY
Current Priorities
 Cardiac Surgery
 Weekly and 4 weekly monitoring
 Urgency & Risk/benefit Scores
 National Quality Registry/ASCTS
 International Benchmarking
 Acute Coronary Syndrome
 Midlands ACS project, 70% high risk cath by 3 days
 ANZACS QI/ CQI loop
 Australasian Snapshot Audit May 2012
 PCI (stenting)
 ANZACS QI cathlab registry
Waiting lists
 Minimise in November and May
 Cardiac Surgery
 7.5% (5-10%) of annual throughput
 Urgency scores
 Urgency Timeframes



<10 days
<30 days
<120 days
 Risk/Benefit Score
Southern DHB Cardiac Surgery
Cardiac Surgery Waiting Times
Regional Variation in Rates
All Valves and Revascularization
Urgency scoring
Current Priorities
 Cardiac Surgery
 Weekly and 4 weekly monitoring
 Urgency & Risk/benefit Scores
 National Quality Registry/ASCTS
 International Benchmarking
 Acute Coronary Syndrome
 Midlands ACS project, 70% high risk cath by 3 days
 ANZACS QI/ CQI loop
 Australasian Snapshot Audit May 2012
 PCI (stenting)
 ANZACS QI cathlab registry
Midlands ACS Project
Midland ACS - Angiograms done (high risk)
50
People receiving angiogram
45
40
35
30
25
20
15
10
5
0
Angiograms done (high-risk)
Angiograms done within 3 days (high-risk)
Admissions (high risk)
Current Priorities
 Cardiology Services
 MidCentral DHB Cardiology Landscape Report/Project
 Electrophysiology
 Equity of access for SVT ablation and Implanted Defibs
 HRNZ/NHC Afib/flutter ablations economic analysis
 CVD Risk Assessment and Management
 Feedback from PHO performance monitoring
 National Secondary Prevention Monitoring
Outpatient Electives
 FSAs valuable, do not waste them!
 Chest Pain Clinics
 Clinical Pathways, echos, Holters/event monitors
 Non Contact FSAs
 Atrial Fibrillation
 Palpitations
 ?Murmurs
 Cholesterol/BP management
 Minimise F/Us ?via echo/specialist nurse
Current Priorities
 Cardiology Services
 MidCentral DHB Cardiology Landscape Report/Project
 Electrophysiology
 Equity of access for SVT ablation and Implanted Defibs
 HRNZ/NHC Afib/flutter ablations economic analysis
 CVD Risk Assessment and Management
 Feedback from PHO performance monitoring
 National Secondary Prevention Monitoring
Diagnostic EP & Ablation 2010/11
Diagnostic EP & Ablation 2007/8
Defibs 2010/11
Production Planning
 Acutes/Electives
 Coronary Angiography 50/50
 Stenting 70/30
 Pacing/EP 60/40
 Cardiac Surgery 70/30
 Summer, Autumn, Winter, Spring
 Staffing
 School/Public Holidays
 Conferences
 Strikes
Current Priorities
 Cardiology Services
 MidCentral DHB Cardiology Landscape Report/Project
 Electrophysiology
 Equity of access for SVT ablation and Implanted Defibs
 HRNZ/NHC Afib/flutter ablations economic analysis
 CVD Risk Assessment and Management
 Feedback from PHO performance monitoring
 National Secondary Prevention Monitoring
Atherosclerosis coded event linked
to National Pharmacy Database
Summary
 Equity, Access and Quality
 Are the right patients getting the right care in the
right timeframes?
 The most efficient use of resources in the most
appropriate patients
 Better, Sooner, More Convenient