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

CONTINUOUS IMPROVEMENT ACCESS QUALITYEQUITY

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

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