The Lighthouse Project Team: A/Prof Jayme Bennetts; Prof Rob Baker; Daphne Perry; Bronwyn Pesudovs We would like to acknowledge and pay respect to the traditional owners of the land on which we meet – the Kaurna people of the Kaurna Nation. It is upon their ancestral lands that this facility is built.

The Lighthouse Project The Lighthouse Hospital Project: A joint initiative of the Heart Foundation and the Australian Healthcare and Hospitals Association (AHHA), funded by the Australian Department of  Health to improve the Aboriginal and Torres Strait Islander (ATSI) People’s pathway through hospital when presenting with Acute Coronary Syndrome. 

Background The Lighthouse Project casts a spotlight on the leading cause of death for Aboriginal and Torres Strait Islander peoples with 60 per cent likely to die from coronary heart disease. Evidence suggests Aboriginal and Torres Strait Islander peoples experience rates of coronary events, such as heart attack, 3 x higher than non-Indigenous Australians.

Background 20% of Cardiac Surgery at FMC FMC performs 30% of Aboriginal and Torres Strait Islander peoples Cardiac Surgery in Australia Patients come from Northern Territory, Torres Strait Islands and SA Relationship with Royal Darwin and Alice Springs Hospitals and surrounding communities. Patients can travel up to 7,800 kms return In 2002 Northern Territory had highest RHD incidence in the world. Malcolm McDonald, NT Disease Control Bulletin Vol.10, No.2, June 2003

Background Aboriginal and Torres Strait Islander patients: 26 times higher rate of rheumatic fever 20 times more likely to die in hospital with RHD 45 % will receive heart valve surgery at age less than 25 years, compared with 4% of non-Indigenous Australians Will return 2 or 3 times for repeat valve surgery Jonathan R Carapetis, Alex Brown, Nigel J Wilson and Keith N Edwards Med J Aust 2007; 186 (11): 581-586. Hospitalised with Acute Coronary Syndrome Double in-hospital coronary heart disease death rate 40 % lower rate of angiography, coronary angioplasty or stent procedures 20 % lower rate of coronary artery bypass surgery 7 times higher rate of death for 25-34 year-olds from heart disease 45% of Aboriginal men and 34% of women die before the age of 45 Australian Institute of Health and Welfare (AIHW)

Case Study Louise, 24 year old, rheumatic heart disease, first presented to us in 2006 at 14 years of age for open heart surgery for a mitral valve repair. 10 years later represented for mitral valve replacement and tricuspid valve repair. Because she wants children, warfarin is not recommended, so she had a tissue valve inserted. We will likely see her return in 6-10 years time. Presented with permission from Louise Brown, Patient, Lighthouse Project

Lighthouse Project Action Plan ACTION: Ensure Aboriginal and Torres Strait Islander patients are better informed and better prepared for surgery prior to travel. Aim: Improve patient journey for Aboriginal and Torres Strait Islander patients undergoing Cardiothoracic Surgery at Flinders Medical Centre. Domain: Clinical Quality Improvement Objective: Impact the patient journey prior to admission, during hospitalisation and after discharge.

Challenges Identified: Travel – flights, appointments Escort – availability, health All surgery screening requirements – Echo, Angio, dental checks, monitor infections, ceasing medications prior to travel Cultural Obligations – planning surgery around family events Discharge planning - started early, often with referrals prior to surgery (i.e., Heart Failure Unit at RDH) Meeting transport needs - not only for discharge but follow-up appointments Patient review and follow-up prior to returning to remote community Discharge medications - in format/number to assist with compliance Prevention of complications by ensuring education

Addressing Challenges: Staff understanding and cultural awareness Aboriginal and Torres Strait Islander Patient Care Guidelines/ ‘Sad News, Sorry Business’ booklets for staff working in SALHN. Topics include providing culturally safe care, communication aspects of clinical care, i.e., pain management and end of life care.

Addressing Challenges: Staff Cultural Awareness Top Ten Tips Poster, laminated handout

Addressing Challenges: Cultural Awareness/Communication Aboriginal Liaison Officers from FMC’s Karpa Ngarrattendi trained in cardiac and intensive care procedures as well as in-case note documentation.

Addressing Challenges: Waiting List Management CONSULT Change to cardiac surgical waiting list pathway to reduce time remote patients wait for cardiac surgery. A date of three months from time of referral as our current goal. PREPARATION TRAVEL SURGERY

Addressing Challenges: Patient Understanding An Aboriginal and Torres Strait Islander Your Hospital Journey booklet.

Addressing Challenges: Patient Involvement and Understanding A patient welcome package including: Tote bag Toiletries Your Hospital Journey booklet Map of Adelaide Hostels Rights and Responsibilities booklet Magnet Pen Feedback has been very positive

Lighthouse and beyond – Phase III Aboriginal Health Worker as part of CTSU/ICCU staff (Cardiac/ICCU see approx. 30% of all ATSI FMC patients). Cultural Safety/Cultural Competency online training course New Cardiac Surgery Unit with dedicated rooms and meeting area

Thank you