Southern District Health Board

Southern District Health Board Dunedin Hospital 201 Great King Street Private Bag 1921 DUNEDIN, 9054 Chief Executive Officer Phone 03-476 9448 Fax 03-476 9450 24 March 2015 Martin Johnston NZ Herald Email: Martin.Johnston@nzherald.co.nz Dear Mr Johnston Re: Official Information Act 1982 (the Act) request for information Thank you for your request for information received on 16 December 2014. The information you requested was specifically for: I seek information from your DHB regarding the work done at its premises by vocationally registered cardiothoracic surgeons and neurosurgeons. I seek the following information in respect of each vocationally registered cardiothoracic surgeon and neurosurgeon, listed by name of the surgeon and for the financial years 2012/13 and 2013/14: 1. The number of surgery cases (patients), broken down by types of surgeries, 2. The number of patients who had surgery and experienced major complications, 3. The number of patients who had surgery and were readmitted to a hospital within 30 days of discharge, 4. The number of patients who had surgery and died within 30 days of discharge from hospital. In addition to the numbers in the answers to questions 2, 3 and 4, I seek the crude rates of complications, readmissions and mortality for each surgeon; and, if they have been calculated, the standardised rates of complications, readmissions and mortality adjusted for case mix, complexity or other factors that might reflect different patient risk profiles in each surgeon’s patient group. Our response is as follows: The information you have requested represents, with current systems, a complex data extraction followed by an analysis that is not possible. In particular the system from the NHS requires adjustments to the raw mortality figures based on other clinical information not currently readily available here. It has not proved possible therefore to supply all the information that you request. In order to produce the type of reporting that the NHS has we need to start with clinically accurate data collected as part of the process of care. The good news is that work commenced last year to do exactly this for cardiac interventions. A specialised data collection system has been commissioned to cover these interventions which will include the process steps and outcomes in some depth. This project was recently discussed at a meeting of health professionals and DHB staff led by the Ministry of Health. There was support to extend this type of approach to other interventional speciality areas and an undertaking to explore this further. Noting the limits on available data and the work required to do complex analysis we have provided information which differs to that you requested. Attached you will find the data related to major cardiac procedures - being that which was definable and classifiable. Neurosurgery data is more complex with a wide range of interventions and was therefore not possible without considerable work, and even then has significant limitations as a result of our current systems. The data provided is grouped to DHB level for the following reasons: The numbers of procedures per surgeon are at a level that they would not provide statistically secure conclusions to be drawn. The case type by surgeon will differ meaning that some surgeons will have undertaken cases that were more complex or had greater risk factors which we cannot account for by adjustment. Therefore apparent differences would not reflect real differences in mortality or other outcomes. Focus on individual clinicians then may lead to changes in case selection and therefore potential avoidable harm to patients. For example clinicians may feel less willing to take on complex cases because that may create an apparent poor outcome rate. Focus on individual clinicians may also lead to less active participation in measures to improve quality of care through collection of information such as that indicated above in relation to cardiac interventions. Clinicians do have a reasonable expectation of protection from unfair criticism based on information in which we do not have full confidence as is explained above, and which results from the limitations of the data gathering systems in current use. This is a different situation from that which there is already justifiable concern about the practice of an individual. Noting the limitations on the information we have been able to provide we would like to offer you an opportunity to meet with one or two of our clinical leaders to discuss the matter in more detail. Some of the Chief Medical Officers would be open to this and we ask you to contact Dr Nigel Millar at Canterbury DHB should you wish to take up this offer. 1. The number of surgery cases (patients), broken down by types of surgeries, For Cardiothoracic Surgery Cardiothoracic Coronary Bypass With Invasive Cardiac FY 12-13 FY 13-14 31 49 Investigation Cardiac Valve Procedures With CPB Pump Without Invasive Cardiac Investigations Major Chest Procedures Coronary Bypass Without Invasive Cardiac investigations Major Chest Trauma Other procedures < 10 cases pa TOTALS 23 35 15 16 25 21 13 65 163 13 91 234 FY 12-13 FY 1314 43 23 12 9 5 5 7 6 78 188 61 48 18 13 14 14 11 11 90 280 For Neurosurgery Neurosurgery Cranial Procedures Other Back and Neck Procedures Other Disorders of the Nervous System Spinal Procedures Carpal Tunnel Release Spinal Fusion Intracranial Injury Non-surgical Spinal Disorders Other procedures with < 10 cases pa TOTALS 2. The number of patients who had surgery and experienced major complications Cardiothoracic Complications of cardiac and vascular implants (excluding septicaemia) Ventricular fibrillation / cardiac arrest Complications of other implants (excluding septicaemia) Hospital-acquired paralysis AMI Asphyxia and respiratory arrest Pressure Ulcers Enterocolitis dt Clostridium difficile Pulmonary Embolism (PE) Foreign body or substance left following a procedure Cardiothoracic Totals Neurosurgery FY 1213 FY 1314 19 40 8 2 6 4 1 4 1 1 1 47 14 10 6 5 6 3 2 2 88 Complications of other implants (excluding septicaemia) Pressure Ulcers Hospital-acquired paralysis Complications of cardiac and vascular implants (excluding septicaemia) Ventricular fibrillation / cardiac arrest AMI Asphyxia and respiratory arrest Falls with fractured femur Patient self-harm (including intentional and undetermined intent overdose) Pulmonary Embolism (PE) Neurosurgery Totals 12 6 3 3 7 9 9 4 3 1 1 1 1 1 27 34 Note that these numbers reflect complications, not patients. 31 patients appear twice (two complication codes) and four patients appears three times (three complication codes). 3. The number of patients who had surgery and were readmitted to a hospital within 30 days of discharge. FY 12-13 FY 13-14 Cardiothoracic No readmission within 30 days 143 205 Readmission within 30 days 20 29 Neurosurgery No readmission within 30 days 169 233 Readmission within 30 days 19 47 4. The number of patients who had surgery and died within 30 days of discharge from hospital. FY 12-13 FY 13-14 Cardiothoracic No death within 30 days 155 230 Death within 30 days 8 4 Neurosurgery No death within 30 days 182 264 Death within 30 days 6 16 Yours sincerely Carole Heatly Chief Executive Officer