Clinical performance metrics released in October 2023 painted a somewhat dreary picture of how Hawke’s Bay Hospital is performing.
However, since the metrics were released, the hospital has been working hard to improve the services that under-performed.
BayBuzz questioned the hospital about what it was doing to improve its performance in these areas:
- immunisation coverage for children fully immunised for age at 24 months,
- ambulatory sensitive hospitalisations,
- mental health wait-times for those 25 and under,
- acute bed days,
- patients waiting longer than four months for first specialist assessment,
- ED presentations.
In an Official Information Act (OIA) response, Hawke’s Bay Hospital’s acting group director of operations, hospital and specialist services Paula Jones addressed each area.
Immunisation. Coverage for children fully immunised for age at 24 months in Hawke’s Bay fell from 83.3% to 79.1% (April to June 2022, and April to June 2023).
Jone said Te Whatu Ora was working in partnership with Te Aka Whai Ora and local providers to reach the national target of 90 percent immunisation coverage for tamariki at 24 months by June 30, 2024.
Te Whatu Ora Hawke’s Bay has also increased the hours of immunisation drop-in clinics at Napier Health Centre and Hawke’s Bay Hospital.
“This year, Te Whatu Ora Hawke’s Bay collaborated with Whānau Āwhina Plunket to establish a new immunisation drop-in clinic at Whānau Āwhina Plunket Hastings,” Jones said. “This community-based clinic makes it easier for parents to immunise their pēpi and tamariki. In conjunction with our Central Region colleagues, we are also working on building workforce capacity. These measures are expected to lift Hawke’s Bay’s immunisations statistics which dropped slightly.”
She added several factors could impact immunisation rates such as difficulties enrolling with a GP, cost of living, housing shortages and weather events like Cyclone Gabrielle.
Ambulatory sensitive hospitalisations had increased substantially for 0 to 4 years of age from 6741 to 7869 over the same period.
Jones said these hospitalisations were acute admissions which are considered potentially reducible through interventions deliverable in a primary care setting.
“Te Whatu Ora Hawke’s Bay works alongside the Primary Health Organisation, Health Hawke’s Bay on health pathways that address conditions such as respiratory illnesses which make up a large number of admissions in this age group,” she said. “In addition, Te Whatu Ora Hawke’s Bay Child Health Team has introduced a new initiative working with whānau and tamariki in high-risk suburbs to provide health care and advice on respiratory and skin conditions.
“All children who are admitted to the Emergency Department or ward are also followed up on within days of their discharge. This may include a home visit, education and/or referral to appropriate services including GPs.”
Mental health wait-times for those aged 25 and under have seen improvement.
Jones said there were several factors behind it. “The Mental Health team in Hawke’s Bay has undertaken a number of improvements to services, processes and systems.”
She gave the example of Child Adolescent and Family Services (CAFS) which reviewed its referral process and how patients are triaged. “The service has introduced a daily team meeting for the multidisciplinary teams to discuss the initial assessment process. This has reduced the time it takes to triage patients and respond to referrals.”
CAFS has also managed to streamline its processes by having a psychologist and intern psychologist in the intake team who determine more complex presentations, she said. “Intervention responses are relatively quick and having a clinician who offers short-term child behaviour therapy (CBT) has contributed to these shorter wait times.”
Acute bed days had increased in the reporting period. Jones said Te Whatu Ora Hawke’s Bay had introduced several initiatives to reduce the time a patient spent in hospital, noting that an additional physician has been added to the Acute Assessment Unit between the hours of 2pm and 8pm, enabling later discharging.
An extra 10 beds (subject to acute demand) were also added to the Assessment Treatment and Rehabilitation (AT&R) and the Medical Day Unit (MDU) expanded to take GP referrals for day stays.
Specialist assessment. Patients waiting longer than four months for first specialist assessment (FSA) had also showed an increase.
Jones said several specialities had made significant inroads into reducing waiting times. “However, workforce pressures and continued demand for services have impacted the FSA wait times in Hawke’s Bay for 2023,” Jones said. “The Central Region has committed to working together in 2024 to sustainably reduce FSA wait times.”
ED presentations for the same period also showed an increase. To reduce numbers, Jones said Te Whatu Ora Hawke’s Bay worked alongside the PHO Health Hawke’s Bay on primary care initiatives to try and alleviate the number of presentations to the Hospital Emergency Department.
“Te Whatu Ora announced a funding package in May 2023 securing free GP or Registered Nurse visits for rangatahi aged between 14 and 24 years,” she said. “This is secured for the next two years. This encourages rangatahi to access GP services rather than visiting ED.”
Cancer treatment within 31 days of a decision to treat by a health professional also showed a marked decrease.
Jones said the ongoing impact of Cyclone Gabrielle had affected many services and, in this case, targets being met. “With treatment outcomes spanning services which have also been impacted by Cyclone Gabrielle, this has a flow on effect. Te Whatu Ora Hawke’s Bay is working hard to improve the 31-day target and taking an in-depth look at contributing factors and how to manage these moving forward.”
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