diagnostic & support services group may 2007 1. service ...€¦ · diagnostic & support...

Diagnostic & Support Services Group May 2007 1. Service Summary Breast Care Services • The installation of Digital Mammography in Southland will be undertaken in June 2007. The cottage at Southland

Hospital will have a minor upgrade to facilitate the installation of digital equipment as required. • Recall women are not being screened within the required timeframe of 24 months due to digital implementation,

staffing and industrial action. • Dr Anusha Niadoo, who has completed a fellowship in Mammography, has been appointed to a 0.5 FTE

Consultant position and will begin work with the service in June 2007. Dr Niadoo will also be working 0.5 FTE in the Radiology department.

• Numerous compliments have been received from women on the new facilities. The Whanau room is very tranquil and relaxing, and women feel very comfortable discussing their assessment outcomes in this environment, rather than a clinic room.

• Barbara Brinsley, a member of the Otago DHB Art Advisory Committee, has done a wonderful job displaying existing artworks and obtaining new art for the new facility.

Radiology • The Radiology Information System (RIS) continues to be a major problem to the department, with workflow being

severely hampered by the slowness of reporting and registration, impacting upon report times and workload. • The issues with RIS have impacted upon progressing other initiatives, such as voice recognition reporting trials,

and on overtime. The RIS vendor, IT and Radiology staff are working through the issues log in conjunction with the Otago DHB Quality Manager and Diagnostics Project Manager.

• The ability of the service to meet clinical demand remains a concern. The wait time for non-urgent MRI referrals is 48 weeks (target of 16 weeks) and 40 weeks for non-urgent CT (target of 12 weeks). Options are being explored to mitigate this situation, with some referrals being outsourced in addition to alternate Saturdays being used for CT and MRI. The imaging of CT referrals by Timaru Hospital has been limited; of over 200 patients contacted to date only 60 have indicated a willingness to have their scan undertaken at Timaru Hospital.

Hotel Services • Potential industrial action has been the main focus for Hotel Services in May, with the food service, security,

orderlies and cleaners all having members of the Service & Food Workers Union (SFWU). Stop work meetings have been held and strike notices issued until the end of June. Contingency planning has been a priority, though strike notices so far have been withdrawn.

• The next stage of the waste initiative has been delayed due to the potential SFWU industrial action. The planned commencement of recycling at Dunedin and Wakari hospitals, staff training, the lock down of the compactor bay and placement of the waste compactor at Wakari hospital have all been rescheduled for after the strikes.

Therapies • A lack of senior clinicians nationally is causing serious concerns regarding skill-mix. Tania Wyatt, Recruitment

Adviser, has developed an active strategy for recruitment into senior Allied Health positions with the Physiotherapy, Occupational Therapy, ISIS and Care of the Elderly services. The strategy has particular emphasis on the UK market and a good range of interest is being expressed by various Allied Health clinicians.

• The proposal for the provision of the Maori Health Liaison service is due to go out for consultation in June 2007. Sterile Supply Unit • Capital applications for batch washers for the Central Sterile Supply Department (CSSD) and Theatre Sterile

Supply Unit (TSSU) were submitted to the May Clinical Board and at the Clinical Board’s request will be resubmitted to the July meeting along with capital applications for autoclaves and modifications to the steam supply.

Infection Control • An Infection Control Nurse from Gisborne Hospital has been recruited to the vacant position and will commence in

the role in June 2007. • The last Influenza Vaccination Campaign clinic was held at the end of April 2007, with the overall uptake by staff

being 30% (the target was 50%). • A draft debriefing paper on the Norovirus outbreak has been prepared and once complete will be presented initially

to Wards 8A and 8B, and then more widely. There continues to be cases of vomiting and diarrhoea presenting to ED.

HAC report – April 2007 22/06/2007 Group Manager – Sonja Dillon

2. Contractual Performance

Actual Planned Variance Actual Prior Year Actual Planned Variance Actual Prior

Year

Community Referred Radiology 1,075 1,829 1,829 15,073 16,913 16,913

ACC High Tech Imaging 91 121 91 1,009 1,410 1,410

Breast Screening (Total women screened) 1,219 1,569 1,406 10,809 13,844 10,986

Age Group 45 - 49 124 298 261 1,691 2,629 2,104

Age Group 50 - 64 798 1,067 980 7,156 9,415 7,440

Age Group 65 - 69 297 204 93 165 1,962 1,800 162 1,442

Radiology Utilisation (ODHB patients) 6,377 6,701 6,701 62,832 59,068 3,764 59,068

Dietitian Clinics 219 234 231 1,930 2,566 2,502

Hospital Meal Equivalents 43,293 46,944 46,944 447,742 504,268 504,268

Physiotherapy Outpatients MOH 1,215 1,414 1,558 13,696 14,586 13,157

Physiotherapy Outpatients ACC 622 714 836 6,116 6,850 6,256

Month Year to Date

(754) (1,840)

(30) (401)

(350) (3,035)

(174) (938)

(269) (2,259)

(324)

(15) (636)

(3,651) (56,526)

(199) (890)

(92) (734) • Radiology activity was down in May due to industrial action and issues with the Radiology Information System. • Breast Screening activity was down in May due to industrial action and the implementation of digital

mammography. • Dietitian Clinics variations for May are due to leave, year to date variances are due to leave, vacancies, locum

cover withdrawal and increased in-patient activity. The waiting list is also down due to a drop in referrals, an investigation is to be done into this.

• The variation in Hospital Meal Equivalents is due to a change in the method of data collection and a ward closure at Wakari. The Actual Prior Year figures included 'nil by mouth' patients.

• Physiotherapy volumes are down due to vacancies, annual leave, support for the inpatient team due to skill mix issues, preparation for accreditation and induction for new graduates.

3. Resource Management

Actual Budget Variance 05/06 Actual Vacancies Actual Budget Variance 05/06 Actual SMOs 8.53 9.18 0.65 13.10 2.80 9.18 9.18 - 12.61RMOs 11.48 7.00 11.70 0.00 11.48 7.00 10.48Nursing 11.27 12.87 1.60 13.10 0.70 12.44 12.87 0.43 12.83Allied Health 128.29 137.91 9.62 186.04 4.40 133.96 137.90 3.94 186.94Other 155.70 152.18 146.09 3.80 150.08 144.88 149.10Total 315.27 319.14 3.87 370.03 11.70 317.14 311.83 371.96

Year to Date FTE Month FTE

(4.48) (4.48)

(3.52) (5.20) (5.31)

• The key gaps that remain are clinical and technical. • Vacancies for 3.9 FTE were approved for recruiting in May 2007.


4. Financial Performance Net Result ($000)

Actual Budget Variance Actual Budget VarianceRevenue 1,008 898 110 10,216 9,570 646 Personnel (1,701) (1,522) (16,491) (15,352)

(1,056) (1,073) (17) (10,107) (10,727) (620) (1,749) (1,697) (16,382) (16,509) (127)

179 1,139 Expenses

Surplus/(Deficit) 52

Month Year to Date

Revenue: $110k favourable variance for the month; • MOH - Personal Health $14k

• $12k – Breast Screening volume achieved for the month, at 1,219, was 57 ahead of the budget volume of 1,163 {Target Screenings for KPI was 1,569}.

• MOH - Vote Health $32k • $32k –CTA Revenue for Radiology Registrars is now paid at a higher rate with the change in year and with one

additional RMO in place. CTA Revenue received for the Histology RMOs. The salary costs for these 4 RMOs are charged back to SCL Otago Southland, net of their CTA revenue.

• Internal Funding $28k • $35k – Outpatient Drug Sales – demand driven. • ($7k) - Patient Drug Sales – demand driven.

• Other DHB’s ($42k) • ($41k) – Drug Sales to Southland DHB as a result of them sourcing Cyto-Toxic Drugs direct from Baxter’s. In

May income was up, continuing recent trend, at $30k, due to TPN’s supplied. • Other Government $25k

• $25k – ACC Revenue. Most of the additional revenue was from MRI scans, at $83k which is $18k up on budget. This is a reversal of previous trends where revenue had been well under budget. This month’s result is due to picking up additional work from Marinoto, who could not deal with all their ACC cases this month. Volumes expected to return to the recent trend next month. Other area to show increased ACC revenue was Nuclear Medicine, with 25 cases invoiced this month.

• Other Income $55k • $11k – Drug Sales to Private Patients for Trastuzumab (marketed under tradename Herceptin). YTD Total

sales are $165k. • $33k – Charge backs to SCL Otago Southland for salaries (RMOs, Joint Clinical and SMO) and Utilities

provided. This covers costs of Laundry, Cleaning, Orderlies, Software and IT Network charges. Rental of space is credited back to Building & Property.

Personnel: ($179k) unfavourable variance for the month; • Medical Personnel Costs ($79k)

• $43k – Vacancies in Radiologists, Breast Care Consultant and Radiology RMOs. • ($33k) – Radiologist Allowances for workload associated with vacancies (see above) and additional sessions

to cover ACC work, which was not budgeted. • ($22k) – SMO back-pay accrual. • ($13k) in Radiology Registrars as a result of overtime (1.42 FTE) worked to cover non-compliant roster and

vacancies of 1.86FTE. • ($50k) in medical salaries for 4 RMOs, SMOs and Joint Clinical Staff employed in Laboratories not budgeted

for. This has been recharged to SCL, net of the CTA revenue – see revenue comment above. • ($10k) – Negative FTE savings budgeted in Group Manager Support.

• Allied Health ($66k) • ($100k) – Back pays accrued for MRTs, Sonographers and Pharmacists. • $51k - MRT & Sonographers ordinary FTE 7.52, as a result of vacancies and industrial action by APEX union

members. • $16k – Physiotherapist ordinary FTE 3.96, as a result of vacancies. • ($17k) – MRT & Sonographer increased allowances paid in Radiology, Radiology Overheads & MRI - paid for

additional shift worked in the weekend to clear Radiology backlog, assisting with Easy-RIS issues and private MRI cases.

• Management & Administration ($35k) • ($23k) – Administration and clerical associated with additional (2.54) ordinary FTE and (0.68) overtime FTE in

Radiology, across all modalities, as part of the Easy-RIS implementation. • ($4k) – Negative FTE savings budgeted in Group Manager Support.


Other Expenses: $17k favourable variance for the month; • Treatment Disposables ($46k)

• ($21k) – Blood - Platelet Components; High costs due to 1 Dialysis patient receiving 3 units Cryodepleted Apheresis, 3 times per week (199 units since Dec 06) at $420 per unit. Cost for May was $15k. Course of treatment has concluded.

• $25k) – Blood – Red Cell Components; High usage this month due to acute demand for Red Cells Resuspended - Leucocyte Depleted, with 495 units used compared to YTD monthly usage of 411.

• Instruments & Equipment $36k • $32k – Clinical Equipment - Service Contracts; Reduced cost of servicing based on separate contracts

negotiated with Philips, GE, Siemens and Kodak – previously all with Philips. • Hotel Services, Laundry & Cleaning $52k

• $20k – Patient Meals on Wheels costs, due to an accounting correction of prior months over accrual. Correct costs shown YTD.

• $18k – Food & Groceries (Fruit & Vegetables, Meat & Poultry, Dairy, Groceries & Other, Nutritional Supplements); Reduction across all food groups this month as result of recent contracts negotiated. YTD savings on Food purchases is $247k against budget.

• Implants & Prostheses ($15k) • ($15k) – Shunts & Stents in DSA as additional procedures performed.

• Outsourced Clinical Services ($97k) • ($36k) – Laboratory send-away tests: allowance made for estimate of Laboratory tests performed by SCL

Otago Southland since August 2006. No account has been received to date. • ($45K) – Breast Screening: estimate for Pathology services provided by SCL Otago Southland since August

2006. No account has been received to date. • Other Operating Expenses ($28k)

• ($17k) – Printing of the Pharmacy Formulary account received this month. Had been budgeted under Outsourced Clinical.

• Pharmaceuticals $107k • $23k – Pharmaceutical purchases, mainly due to reduced volume from Southland DHB. • $81k – Pharmac rebate received for Hospital Pharmacy passed on by Funder arm.

Chris Lovell-Smith Sonja Dillon Debi Lawry Clinical Director Group Manager Nursing Director


HAC report – May 2007 22/06/2007

Group Manager – Dr Colleen Coop

Emergency Medicine & Surgery Services Group May 2007 1. Service Summary

• The completion of the joint initiative may yet be achieved despite industrial action. Although operations completed

to date are just under the target of 475, procedures completed in other DHBs (inter-district flows) may yet see us achieve the target. Final results will not be available until the middle of July.

• The effect of industrial action has been felt widely across all services. The cumulative effect of several groups of staff carrying out industrial action, and the sustained nature of the action, now stretching into its third long month, has meant that elective activity has been reduced for much of June. Some areas are suffering from “hidden” effects – on call and overnight action of diagnostic staff places the Emergency Department (ED) in the position of being unable to carry out all required assessments that result in being able to move patients out of the department, creating access blockage, overcrowding, high nurse: patient ratios and backlogs and delays in treatment. We are also concerned that the reduction in activity will affect compliance in the Elective Services Performance Indicators (ESPIs) moving away from green results which have been hard won, and back into orange and red.

• Despite the challenges faced by the services, described above, we were very pleased to maintain compliance on all elective service performance indicators, for all services, for the month of April (formal results are 6 weeks behind).

• Pressure on the Emergency Department continues. Some short term steps have been taken to mitigate the stress on staff, however systemic issues of Patient Flow will take some time to address. In the meantime, increasing acuity of patients, and difficulty in accessing beds means that at times waiting times are long and nursing staff stretched to provide care for many patients at a time. Staffing shortages on the wards (primarily nurses) means that the full complement of beds cannot be opened; one root cause of access block in ED. Consideration needs to be given to reviewing our staffing skill mix if we are unable to employ as many registered staff as we would like.

• The Patient Care Plan is a finalist project in the Otago District Health Board Quality Awards. It is great to see the efforts of all staff in implementing this project recognized.

Emergency Department (ED) • The ED continues to experience staff shortages, access block to inpatient beds and consequent high patient/nurse

ratios – all of which create significant stress within the department. The start of the Patient Flow project may help to ease stress by reviewing the issues in a formal way to develop possible solutions.

Internal Medicine • Both internal medicine wards have high vacancies, the service is actively recruiting but there has been very little

response.

Gastroenterology • Nil issues of note this month

General Surgery

• Industrial action during the month has resulted in a reduction in elective surgery and it is expected that this will impact on the numbers of patients waiting longer than 6 months for treatment. The ability to treat many of these patients has been further impacted on by the long waits for radiological investigations.

• The call reminder system pilot in urology continues with an increase from 5% to 30% confirming their appointments electronically this month. Patients who do not contact us appear to be out of town patients as toll calls are not included in the pilot.

Specialist Surgery: • There has continued to be a push on reaching the 475 goal for joint procedures, there were 70 joints completed in

May. With one month to go the medical and ward staff are positive and motivated to achieve as far towards the target as is possible.

• The use of four vac dressings during May will contribute to the dressings (treatment consumables) being over budget. The cost of the machine to hire and supplies are approx $1,000 per week. There was a total of 75 days of use by these four patients.

• The Charge Nurse Manager (CNM) of Ward 5b, Blair Donkin, has resigned as of the 22 June 2007. Blair has been a valuable leader within the Group and will be missed.

HAC report – May 2007 22/06/2007


• The ENT Service continues to monitor waiting list times and first specialist assessments (FSAs) to keep ESPIs green.

• Ophthalmology Department ESPI data remains green although 40-60 routine FSA referrals are sent back to referrers each month. Urgent and semi urgent referrals are being seen within recommended timeframes.

• The Rheumatology job sizing is in its final stages and will be finalised soon. Cardiology (Diagnostics) • Medical Radiation Technologist (MRT) strikes continue to be very disruptive to the elective and acute angiography

lists due to the restricted imaging times available. Cardiology / Respiratory / Coronary Care Unit (Wards) • Industrial action has had a tangible impact operationally, particularly on renal, cardiothoracic and cardiology

patients. • Ward 7a has reduced its bed numbers (part of the initiative to increase beds in the Internal Medicine service) and

this is working well to date. • Ward 7b’s procedure room has been updated and approved by anaesthesia allowing for return of cardioversion

procedures as of beginning of June. • Ward 7c continues to have issues of nursing vacancies – as at the end of June there will be 3.2FTE. Unfortunately

this will mean 7C will be able to roster for 16 inpatients (a reduction of 4 beds) unless staffing shortfalls are corrected.

• The majority of elective admissions were cancelled for the last week of May due to industrial action. However, this has allowed the acute angiography backlog from MRT action to be cleared.

Cardiothoracic Surgery • Cardiothoracic surgery lost all elective lists from Monday 28th May due to industrial action, plus 4 elective lists

cancelled due to anaesthetist shortages. • A cardiothoracic registrar arrived in late May, with another expected in early August to bring the service back to full

complement of junior medical staff. Renal Dialysis Unit • The Senior Medical Officer (SMO) job sizing has been completed and the service will begin recruitment for an

additional 0.50 FTE. Endocrinology • Nil issues of note this month. Oncology / Haematology • Tentative enquiries from someone interested in the Palliative Care Physician position have come to nothing so

advertising continues. • Staff in the service are actively working on creating the necessary infrastructure to introduce a Southern Blood and

Cancer regional waiting list for treatment. • We are pleased that we have secured a haematologist from the United Kingdom, due to commence work in

January 2008 with a small chance of an earlier start date. Radiation Oncology • The second 21EX linear accelerator (linac) installation is progressing to schedule with no major problems to date.

Commissioning is due tentatively for August 2007. • Despite the sabbatical leaves of two medical staff outpatient first specialist assessments (FSA) volumes have been

maintained and therefore no patients have been disadvantaged during this period as was anticipated initially. Ward 8C • One of the nursing scholarships awarded recently went to a Ward 8c registered nurse to undertake post graduate

research and education.

Anaesthesia: • Registrar numbers are currently one down, compounding the difficulties of running all theatre lists because

Specialist numbers are severely depleted, further exacerbated by unexpected sickness leave. A consultant locum who was to arrive 2nd July has rescinded his plans and will not now be coming.

• Although theatre technicians are fully staffed, 2 FTE are on long term sick leave – 1FTE on long term non-work related ACC, the other recovering from an operation.

HAC report – May 2007 22/06/2007


Day Surgery Unit (DSU): • 87% of available DSU lists had patients booked to them, with 332 patients passing through DSU in May.

Significantly there were 39 patients cancelled on the day of surgery. Three cancelled lists accounted for 30 postponed patients due to surgeon or anaesthetist unavailability.

Intensive Care Unit (ICU): • 62% of ICU admissions were acute and unplanned. There was high mortality this month with one debriefing of staff

following an “unexpected” death. • A total of 9 nurses are undertaking post graduate study, with one staff nurse booked to attend an Advanced

Paediatric Life Support course in Auckland, and 2 nurses attended a palliative care conference. Two participants per month are completing or updating Advanced Cardiac Life Support Level 6.

• Benchmarking figures have been obtained for 2005/2006. Otago District Health Board compares favourably with other tertiary ICUs in NZ and Australia. Areas for special commendation are minimal length of time of invasive ventilation, high proportion of Critical Care Qualified nursing staff, low readmission and “late in the day” discharge rates, zero nursing vacancy rate.

Post Anaesthesia Care Unit (PACU): • Reduced theatre lists due to planned strike action and anaesthetic staff vacancies have affected PACU operations,

but a busy month for eye day surgery. Two extra eye surgery lists are planned for June to complete the full number of Cataract Initiative procedures for the 06/07 financial year.

• Approval for 4 PACU staff to complete a further post graduate module from Deakin University in Post Anaesthetic Care was given, made possible by assistance from the Charitable Trust.

Pain Service: • A busy first half of the month for the Acute Pain Service with higher numbers of epidural infusions. The service is

continuing to establish a working liaison with the Palliative Care Nurse. • The service continues with ward staff certification for epidural care and PCA pump practical demonstrations.

Main Operating theatre (MOT): • With dropping of some Elective lists due to strike notice, MOT has run extra acute lists. • The computers have been installed in each theatre. Teaching sessions will be arranged. • The Associate Charge Nurses had the opportunity to co ordinate on a daily basis whilst the Charge Nurse Manager

was on leave. This was an excellent learning curve and they performed well. 2. Contractual Performance

2.1 Surgery Contract Volumes

Month Year to date

Actual Planned Variance Actual Prior

Year Actual Planned

Variance

Actual PriorYear

Surgery_Group_ODHB_Acute CW 323.40 489.07 (165.67) 518.09 5483.08 5391.77 91.31 5335.4Surgery_Group_ODHB Acute IDF CW 251.91 61.41 190.50 104.94 881.98 655.09 226.89 968.91Surgery_Group_Elective CW 560.40 503.48 56.92 538.67 5194.23 5175.74 18.49 5251.4Surgery_Group_Elective IDF CW 41.11 38.11 3.00 61.36 528.90 421.18 107.72 498.11

Surgery_Group_TOTAL CW 1176.82 1092.07 84.75 1223.06 12088.19 11643.78 444.41 12053.82

Month Year to date


Year Actual Planned

Variance

Actual Prior Year

Group FSA 1215 1267 (52) 1264 11368 12868 (1,500) 12182

Group Follow Up 3099 3396 (297) 3840 32871 35326 (2,455) 35011

Group Other 1144 1084 60 967 11260 11388 (128) 9999

HAC report – May 2007 22/06/2007


2.2 Medicine Contract Volumes

Month Year to date

Actual Planned Variance Actual

Prior Year Actual Planned

Variance

Actual PriorYear

ED_Medicine_Group_ODHB_Acute CW 718.38 797.93 (79.55) 777.82 8334.02 8659.11 (325.09) 6727.38ED_Medicine_Group_ODHB Acute IDF CW 185.43 120.03 65.40 156.53 1436.26 1292.57 143.69 1210.43ED_Medicine_Group_Elective CW 108.24 86.92 21.32 100.39 999.64 867.13 132.51 2972.24ED_Medicine_Group_Elective IDF CW 43.88 58.00 (14.12) 33.12 555.05 590.68 (35.63) 477.88

ED_Medicine_Group_TOTAL CW 1055.93 1062.88 (6.95) 1067.86 11324.97 11409.49 (84.52) 11387.93


Year Actual Planned

Variance

Actual Prior Year

Group FSA 479 459 20 468 4340 4786 (446) 4080

Group Follow Up 1557 1405 152 1578 14865 14796 69 13493

2.3 ESPI

May

06 Jun

06Jul06

Aug 06

Sep 06

Oct06

Nov06

Dec06

Jan 07

Feb07

Mar07

Apr07

May 07

ESPI 2 (FSA) – Number people who have been seen within 6 months

1756 1451 1414 1711 1604 1709 1656 1202 1066 1481 1622 1362 1774ESPI 2 – % of people who have been seen within 6 months 91% 93% 94% 93% 94% 98% 96% 98% 95% 94% 95% 95% 94%ESPI 5 – Number of people who have received their treatment within 6 months 457 330 449 456 352 436 417 340 194 354 416 367 496ESPI 5 – % of people who have received their treatment within 6 months 84% 76% 86% 87% 87% 87% 92% 91% 89% 86% 89% 90% 90% 3. Resource Management Month FTE Year to date FTE

Actuals Budget Variance 05/06

Actuals Vacancies Actuals Budget Variance 05/06 Actuals

Staff Group May-07 May-07 May-07 May-06 May-07 May-07 May-07 May-06

SMO 75.64 74.97 (0.67) 73.29 10.9 76.59 75.00 (1.60) 12.61

RMO 114.32 111.62 (2.70) 115.18 2.60 112.44 111.62 (0.82) 10.48

Nursing 459.08 466.04 6.96 455.46 25.49 460.04 466.04 6.00 12.83

Allied Health 79.65 78.63 (1.02) 79.02 1.30 79.11 78.63 (0.49) 186.94

Support 0.13 - (0.13) 9.04 1.40 5.70 7.30 1.60 93.28

Mgmt / Admin 102.62 104.98 2.36 104.48 5.54 103.08 105.53 2.45 55.82

Total 831.44 836.24 4.80 836.47 47.23 836.96 844.11 7.15 371.96

4. Financial Performance Net Result ($000) Month Year to date

Actual Budget Variance Actual Budget Variance Revenue 1,386 902 484 10,566 9,172 1,394 Personnel (7,128) (5,808) (1,320) (64,738) (61,349) (3,390) Expenses (3,457) (3,216) (241) (32,083) (32,174) 91 Surplus/(Deficit) (9,198) (8,121) (1,077) (86,255) (84,350) (1,905)

HAC report – May 2007 22/06/2007


ime. The overtime variance for the year is now ($720k) • Nursing r

g overtime) • $50k – Allowances paid under budget

sthesis corresponding to the increase in number of

• Instrum ts

• and maintenance on the C-arm in Cardiology Labs ($15k), and

Outsourced Medical Labour ($54k) – Includes April and May Ophthalmology clinics not budgeted for ($27k) and R ardiac Surgery ($21k FTE decrea

Dr Shaun Costello Clinical Director (Med)

Dr Colleen Coop Group Manager

Kim Caffell Nursing Director

Revenue $484k favourable: 44 joint initiative procedures were performed in May against a budget of 18 resulting in a $350k revenue increase to budget. The other major income driver was ACC income which was $70k over budget. Personnel Costs ($1,320k) unfavourable • Medical Personnel ($1,227k)

• ($695k) – Back pay. Made up of job sizing $496k (this has been accrued in corporate before but has now been transferred to the group) and an ASMS accrual of $198k for predicted collective negotiation settlements

• ($195k) – Annual Leave. $137k relates to Senior Medical Officer (SMO) annual leave revaluation adjustment a significant proportion of which relates to an increase in the annual leave rates payable to SMOs compared to budget

• ($114k) – Allowances. Continued impact of extra joint payments and non inclusion of ACC allowances in the 2006/07 budget

• ($60k) – Overt Pe sonnel ($80k) • ($71k) – Annual leave. • ($44k) – Increase in rates paid (includin

Other costs ($241k) unfavourable: Significant variances for the month include: • Implants and Prosthesis ($136k). Increase in orthopaedic pro

procedu s re performed in the month en and Equipment ($59k) – Made up of 3 variances: • Repairs and maintenance on 21EX Linac ($27k)

Repairs• Adjustment to Radiation Oncology IMPAC service contract expenditure due to receipt of actual invoice

($10k) •

MO locum cover in C ), offset by an RMO se

Dr Bill Buchanan Clinical Director (Surgery)

Dr Colleen Coop Group Manager

Sharon Jones Nursing Director

Emergency Medicine & Surgery Services Group APPENDIX ONE – Theatres Utilisation Report May 2007 MOT & DSU ListsFull day lists

Jan Feb Mar Apr May JunACUTE Planned lists 50 29 33 34.5 32 29

Extra lists 0 1 0.5 2 4 3Unallocated lists 0 0 0 0 0 0Actual lists 50 30 33.5 36.5 36 32

CARD Planned lists 10 14 13 10 14 10Extra lists 1 1 0 0 1 4Unallocated lists 0 0 0 1 0 2Actual lists 11 15 13 9 15 12

ENT Planned lists 12 19.5 23 18 23.5 20.5Extra lists 0 0 0 0 1.5Unallocated lists 1 0.5 0 2.5 1 3.5Actual lists 11 19 23 15.5 24 17.5

EYES Planned lists 3.5 8 9 8 11.5Extra lists 0 0 0 0 0 0Unallocated lists 0 1.5 1 2.5 0 1Actual lists 3.5 6.5 8 5.5 11.5 10.5

GSURG Planned lists 18 34.5 39.5 34.5 37 30.5Extra lists 0 0.5 1.5 1 2 2.5Unallocated lists 1 4.5 2.5 1.5 0.5 5.5Actual lists 17 30.5 38.5 34 38.5 27.5

GYNAE Planned lists 8.5 11.5 11.5 11 14 11Extra lists 0 0.5 0 0 0Unallocated lists 0 0.5 0 0 2.5 2.5Actual lists 8.5 11.5 11.5 11 11.5 9

NEURO Planned lists 5 8.5 9 4.5 9 8Extra lists 0 0 0 0 0 0Unallocated lists 1 0 1 0.5 2 3Actual lists 4 8.5 8 4 7 5

ORTHO Planned lists 20.5 31 39 32 41.5 34Extra lists 0 0 2 1 2.5 2Unallocated lists 1 1 0 2 2.5 7Actual lists 19.5 30 41 31 41.5 29

PAEDS Planned lists 1 1 1.5 1 1.5 2Extra lists 0 0 0 0 0 0Unallocated lists 0 0 0 0 0 0Actual lists 1 1 1.5 1 1.5 2

URO Planned lists 3.5 9 8 8.5 10.5 6.5Extra lists 0 0 0 1 0 1Unallocated lists 0.5 0.5 0.5 1 0 0.5Actual lists 3 8.5 7.5 8.5 10.5 7

TOTAL Planned lists 132 166 186.5 162 194.5 163Extra lists 1 3 4 5 11Unallocated lists 4.5 8.5 5 11 8.5 25Actual lists 128.5 160.5 185.5 156 197 151.5

0.5

11.5

0.5

13.5

HAC report – May 2007 22/06/2007


Mental Health & Community Services May 2007 1. Service Summary

Older Peoples Health • The inpatient activity within Older Peoples Health (OPH) continues with a high occupancy rate, particularly ACC

cases. • Nursing vacancies within the service is starting to put pressure on service delivery. Active recruitment is

ongoing. • The Needs Assessment and Service Co-ordination (NASC) waiting time continues to be monitored to ensure

there is a reduction in the number of clients waiting. • The InterRAI electronic assessment tool pilot continues within OPH and Needs Assessment and Service

Coordination (NASC). We await the outcome of a National Business Case for the full implementation of these tools by the Ministry of Health.

• The Otago Exercise Programme is being implemented into the OPH Service and Community Services as a falls prevention strategy. This is a joint initiative between ACC and ODHB and will be based in the community setting. A candidate has been appointed to this position.

Rehabilitation Service • The inpatient ward volumes have increased again now that the Senior Medical Officer (SMO) is back from leave.

Limited cover was being provided by the OPH Service. • Dr Lyle Gross, Rehabilitation Specialist, has accepted a SMO position and commences in July. • Provision of physiotherapy services is being monitored due to numerous vacancies existing in both ward and

community settings. All vacancies are being recruited to. • Other vacancies continue to put pressure on the service, particularly Occupational Therapist and Speech

Language Therapist vacancies. • A Request for Proposal has been submitted to ACC for an updated Active Rehabilitation Contract for Moderate

to Severe Traumatic Brain Injury. • Feedback has been provided on the national consultation document for long-term funding for Chronic Medical

Conditions.

Community Services • Heath Co-ordinator and GP Advisor positions are being implemented into the Community Service Co-ordination

Centre (CSCC) as part of the inter-agency Providing Access to Health Solutions (PATHS) programme, in conjunction with the Ministry of Social Development (MSD). Recruitment is in progress and the programme is about to commence when staff are appointed.

• The Group Manager attended a workshop run by ACC to look at the InterRAI electronic tool being used as the assessment tool for ACC. Otago DHB will participate in a wider reference group to have input into a pilot project between ACC and two DHBs.

Mental Health Services • Inpatient numbers have steadied in May with most wards sitting at resourced occupancy levels. Solutions are

being developed with external agencies to address issues with discharge planning from some wards. • Milburn Prison – active discussion and planning is occurring across specialist and relevant adult mental health

teams, with the Department of Corrections. Key operational requirements are now better understood and essential processes which need further development have been identified and progressed. The first Inmates entered the prison on 5th June.

• The Group Manager Mental Health and Community is a member of the Otago Corrections Facility “Switch to Receive” working group.

• Locum Forensic Psychiatrists have been located to cover sabbatical leave; however recruitment of a full time permanent forensic psychiatrist remains a challenge.

• For the month of May 93 bed days at Ashburn Clinic were outsourced to manage mental health service clients. • The ODHB Mental Health Requests for Proposal (RFP) process is expected to be completed by the end of June.

The Provider Arm submissions regarding the Home-based Treatment Service and Post Natal Depression proposals are to be followed up further with the service.

• Feedback has been provided on the national consultation documents for Eating Disorders in New Zealand, the Mental Health Commission Te Hononga and Child and Youth and Alcohol and Other Drugs.

• The Facility Planning project has commenced within the Mental Health Service to review the models of care required for the service provision to inform proposed facilities for master site planning. It is proposed to have models identified within two months.

HAC report – May 2007 22/06/2007 Group Manager – Elaine Chisnall

• SMO vacancies in Mental Health have improved significantly, with the only vacancies being in Forensic Psychiatry and Child and Youth services. The appointed SMO for Mental Health of Older People is to commence in July 2007.

• The service continues to be involved in the national process for reviewing the level of Alcohol and Drug service involvement in the Criminal Justice system.

• The Mental Health services that are located in premises away from Dunedin and Wakari Hospital sites are experiencing increased issues with computer response times. Strategies to increase network speed are being developed with the Chief Information Officer.


Month Year to date


Year Actual Planned

Variance

Actual Prior Year

OPH – Inpatient - DSS 903 992 (89) 948 10339 10908 (569) 10429OPH – Inpatient - ACC 329 225 104 302 2536 2475 61 2688Rehab Inpatient –DSS 261 541 (280) 515 4422 5819 (1397) 4995Rehab Inpatient –ACC 196 225 (29) 89 2583 2475 108 1753OPH – Outpatients 1028 1130 (102) 1010 9042 11374 (2332) 9833Rehab – Outpatients 245 381 (136) 351 2816 3867 (1051) 3014Community Nursing 4712 4738 (26) 4514 48142 47329 813 47358Community Dom OT 377 366 11 430 3377 4034 (657) 3583Comm. Dom Physio 675 632 43 571 5299 6517 (1218) 5911Comm. Continence 207 182 25 192 1497 1830 (333) 1917Community Stomal 128 135 (7) 118 1285 1373 (88) 1492Comm. Home Help 1755 1911 (156) 1856 17310 19215 (1905) 17289MHOP Domiciliary 693 781 (88) 775 7106 7851 (745) 8239OPH – NASC 619 783 (164) 833 8719 7869 850 8974 • Mental Health

KPI May 06

June 06

July 06

Aug 06

Sep 06

Oct 06

Nov 06

Dec 06

Jan 07

Feb 07

Mar 07

Apr 07

May 07

ALOS Target: 21 days 10.8 10.9 11.9 10.7 10.8 15.5 9.9 13.9 13.4 12.8 14.8 13.7 22.3

FSA within 60 days** Target: 100% 81.7% 88.4% 83.7% 83.9% 86.1% 82.3% 82.4% 83.7% 74.6% 75.2% 84.5% 81.5% 83.8%

Occupancy (All wards) 72% 73% 88% 93% 89% 85% 92% 94% 93% 98% 100% 97% 90%

Incl.leave days* 100% 112% 107% 113% 102% 96% 108% 118% 119% 119% 130% 122% 113%Intensive Acute (9B/1A) Excl.leave days+ 94% 98% 93% 93% 87% 80% 90% 95% 99% 108% 112% 103% 92%

Incl.leave days* 49% 53% 98% 98% 96% 86% 91% 98% 100% 108% 109% 105% 92% Clinical Rehab (10B/C/D)

Excl.leave days+ 42% 45% 82% 87% 83% 77% 83% 86% 84% 96% 98% 88% 81%

Incl.leave days* 132% 83% 68% 163% 187% 253% 222% 189% 153% 93% 44% 103% 58% Child & Youth Inpt (1A)

Excl.leave days+ 127% 48% 66% 158% 185% 206% 170% 140% 140% 93% 40% 100% 39%

Comments : Both ‘inclusive’ and ‘exclusive’ of leave days data is provided. The inclusive data shows true workload, the exclusive data shows number of patients in hospital at only one point in time (midnight). *Target for leave inclusive days = 100%. +Target for leave exclusive days = 85% **Seen by Consultant Psychiatrist as non-acute community outpatient. Teams include: Alcohol and Drug; Clutha CMHT; Central CMHT; Waitaki CMHT; Child and Family; South CMHT; North CMHT; Youth Specialities. 3. Resource Management

HAC report – May 2007 22/06/2007

Month FTE Year to date FTE Actual Budget Variance 05/06Actual Vacancies Actual Budget Variance 05/06Actual

SMO’s 25.3 28.1 2.8 23.4 5.0 23.1 28.1 5.0 23.8 RMO’s 26.1 28.1 2.0 27.7 2.0 26.6 28.1 1.5 26.7

Nursing 361.9 372.2 10.3 374.3 26.4 368.8 372.2 3.4 388.9 Allied H. 157.7 172.6 14.9 161.3 12.1 157.6 172.6 15.0 158.2

Other 70.5 73.9 3.4 73.1 4.4 69.9 74.2 4.3 72.8 Total 641.5 674.9 33.4 659.8 50.0 646.0 675.1 29.2 670.4

Group Manager – Elaine Chisnall

• At the end of May there were 50.0 FTE vacancies across the Group. This is causing significant concerns in the

provision of service delivery in multiple areas across the group. • Nursing vacancies have increased again in both the Mental Health and OPH services. • Ongoing vacancies in Allied Health are increasing pressure on services. These include Speech Language

therapists, Physiotherapists and Occupational Therapists. • SMOs in Physical Rehabilitation and Mental Health of Older People are due to commence in July. The SMO

positions for Child and Youth Services and Forensic Psychiatry are still being recruited to. • 6.1 FTE has been reduced within the Group following the organisational review which accounts for the variance in

the ‘Other’ category. 4. Financial Performance Net Result ($000) Month Year to date

Actual Budget Variance Actual Budget Variance Revenue 3,536 3,364 172 38,703 36,844 1,859 Personnel (3,568) (3,749) 181 (37,672) (39,294) 1,622 Expenses (757) (704) (53) (7,474) (7,410) (64) Surplus (Deficit) (789) (1,089) 300 (6,443) (9,860) 3,417 Revenue: $172K favourable for month and $1,859K favourable YTD • $129k ACC Revenue (Physical Rehabilitation) and $16k ACC Revenue (Older Peoples Health), due to high

number of ACC patients. Personnel costs: $181K favourable for month and $1,622K favourable YTD • $181k favourable due to $146k Nursing, $28k Therapies and $74k Allied Health; related to vacancies, a saving in

allowances, less annual leave taken than budgetted and reduced backpay accruals. This is offset by ($63k) unfavourable for Medical due to increased backpay accruals, and backpay for a SMO who had been paid incorrectly.

• 33.35 FTE under budget FTE volume for May. Other costs: ($53K) unfavourable for month and ($64K) unfavourable YTD • ($53k) for outsourced clinical services during May – due to patients managed at Ashburn Clinic ($32k) and

outsourcing of Service Coordination in Rural areas ($26k).

James Knight Elaine Chisnall Heather Casey Debi Lawry

Nursing Director Clinical Director Group Manager

HAC report – May 2007 22/06/2007 Group Manager – Elaine Chisnall

Women’s Health, Children’s Health & Public Health May 2007 1. Service Summary Overview • Significant preparation and activity occurred across Public Health South services for Exercise Cruikshank, the

national pandemic exercise held on the 10th, 16th, 17th and 23rd of May. • Elective service performance indicators continue to be compliant with Ministry of Health standards. • Anaesthetic vacancies as well as the ongoing Industrial action by Laboratory staff, Food and Service Workers and

MRT’s has resulted in additional work to manage workloads and patient flows. • Further work has been undertaken on drafting physical activity and nutrition policy for the ODHB provider arm

which will underpin our responsibility to role model Healthy Eating Healthy Actions by “walking the talk”. • A review of the ODHB’s Smokefree policy is being planned. Children’s Health • NICU occupancy continued to be close to 100% across the month. This is reflective of the demand patterns across

the country and has resulted in an increase of inflows for both Queen Mary Maternity and NICU. Nursing staffing levels are being closely monitored.

• The Ministry of Education audit of the Hospital Early Childhood Education service was undertaken. • Demand for children’s inpatient services was lower than planned. Nursing staff have been redeployed to NICU and

across the organisation. • Paediatric Registrar seniority has resulted in additional work having to be undertaken by Senior Medical Staff

particularly in respect to the care of chronically unwell children and neonatal retrievals. Public Health South – Primary Services • Funding and Planning are presently consulting on proposed changes to the way oral health services are provided

for children and young people as part of the national Community Oral Health Strategy. • The National Screening Unit has yet to advise the new “Go Live” date for implementation of changes to the cervical

screening register. Originally the centralisation of the administration of the cervical screening register was to have commenced 1 July 2007. However due to delays in the project, the National Screening Unit has decided to postpone the start date and is currently amending its timeframe for commencement.

Public Health South – Public Health Services • Public Health South staff were significantly involved in Exercise Cruikshank in terms of planning, undertaking the

exercise scenario and evaluating the performance across Otago and Southland District Health Boards. In addition to the national exercise scenarios, Public Health South exercised biosecurity and quarantine aspects of the plan locally which involved Dunedin and Queenstown Airports, the Port of Bluff and the University of Otago. It was pleasing to see the results of months of intensive planning being exercised so well and staff are to be congratulated for their achievements.

• Planning continues in Public Health which aims to reorientate service delivery towards outcome focussed public health practice.

• Lease contract negotiations have been finalised for the new Public Health South office in Frankton, Queenstown. The move from Lakes District Hospital to the new office is being scheduled for mid July.

Women’s Health • Higher numbers of births and postnatal stays were experienced in the Queen Mary Maternity Unit which resulted in

higher workloads than planned. • The MOH elective service Addressing Disincentives pilot projects regarding Teaching Practice Nurses and Update

for General Practitioners with pessary ring changes and nurse led follow-ups continues. • The externally facilitated monthly maternity service multidisciplinary forum was held again in May. Progress is

being made although it has been decided to extend the forum beyond the original timeframe to the end of the year so as to fully realise the gains being made. As part of this work a small task group has been exploring the concept of a “virtual primary birthing unit”. This concept seeks to articulate the actions and symbols required to represent primary birthing as opposed to secondary or tertiary maternity care. Whilst embracing this concept, forum attendees have expressed support for the establishment of a primary birthing unit and further work is being undertaken to explore this concept.

• The trial of the electronic CPAC (Clinical Prioritisation Access Criteria) tool in Gynaecology continues. • Recruitment activity has been undertaken to fill 3 O & G Registrar vacancies. An emergency roster is being

implemented to cover the lead time before the replacements commence.

HAC report – May 2007 22/06/2007 Group Manager – Pip Stewart


Month Year to date


Year Actual Planned

Variance

Actual PriorYear

Gynaecology FSA1 155 129 26 194 1344 1377 (33) 1339 Gynaecology FUA2 210 163 47 192 1556 1737 (181) 1673 Gynae surgery c/wts3 73 84 (11) 71 752 856 (104) 777 Colposcopy 93 109 (16) 136 937 1191 (254) 1018 Terminations 45 51 (6) 47 469 530 (61) 532 Maternity – Births 162 145 17 134 1634 1572 62 1482 Maternity–P/N stays 153 140 13 133 1543 1517 26 1427 Paed 1st Appt 161 133 28 101 1283 1328 (45) 1319 Paed follow-up App 568 516 52 466 4811 5164 (353) 5118 Paed Acute Assess 88 135 (47) 94 1125 1215 (90) 1111 Paed medical c/wts 40 73 (33) 67 596 660 (64) 700 Paed surgery c/wts 15 17 (2) 14 131 151 (20) 169 NICU c/wts 133 86 47 46 1002 947 55 880 Sexual Health FSA 211 206 5 221 2098 2266 (168) 2145 Sexual Health FUA 128 90 38 142 1151 990 161 1107 • Contributing factors for the variance in activity are:

o Gynaecology caseweights less than planned due to industrial action and anaesthetist shortage o Gynaecology FSA’s and FU’s above plan due to additional clinics being scheduled as a result of dropped

surgical lists. o Medical termination of pregnancy’s are being coded as caseweights which means the number of

terminations reported does not completely reflect actuals. o Paediatric acute assessments and medical caseweights below plan associated with lower acute demand

• Strategies for managing the above are: o MOH elective service Addressing Disincentives pilots project regarding Teaching Practice Nurses and

update for General Practitioners with pessary ring changes and nurse led follow-ups

3. Resource Management

Month FTE Year to date FTE Actual Budget Variance 05/06Actual Vacancies Actual Budget Variance 05/06Actual

SMO 15.12 14.87 (0.25) 14.48 0 14.52 14.87 0.35 15.09 RMO 21.44 21.18 (0.26) 21.29 0 21.35 21.18 (0.17) 19.98 Nursing 125.12 131.01 5.89 128.94 5.60 126.46 131.01 4.55 138.91 Allied Health

92.53 98.09 5.56 84.13 6.40 90.53 98.09 7.56 84.25

Support 0.33 0 (0.33) 0 0 0.17 0 (0.17) 0 Mgmt / Admin

44.87 44.50 (0.37) 42.58 2.0 41.90 44.50 2.60 54.42

Total 299.41 309.65 10.24 291.42 14.00 294.93 309.65 14.72 312.64

1 FSA – First specialist appointment

2 FUA – Follow-up appointment

HAC report – May 2007 22/06/2007 3 c/wts - caseweights

Group Manager – Pip Stewart

4. Financial Performance Net Result ($000) Month – May 2007 Year to date

Actual Budget Variance Actual Budget Variance Revenue 622 607 15 7,453 6,623 830Personnel (1,910) (1,806) (104) (18,840) (19,007) 167Expenses (490) (463) (26) (5,105) (4,845) (260)Surplus (Deficit) (1,777) (1,662) (115) (16,492) (17,229) 737 Revenue: $15k favourable variance • MoH – Personal Health ($23k)

• ($22k) Team Based Midwife revenue less than budgeted due to volumes • MoH – Public Health $35k.

• $40k Public Health side contracts revenue not budgeted (ongoing variance). • $5k Public Health core contract greater than budgeted (ongoing variance). • ($10k) NSP20 High cost treatment due to low volumes and budget difference.

Personnel costs: ($104k) unfavourable variance • Medical: ($164k).

• ($23k) pay rates greater than budgeted stead of corporate. • ($46k) SMO job sizing accrual coded to cost centres now, in

• ($50k) SMO award accrual based on updated calculations. r than budgeted • ($12k ) course fees / professional memberships greate

less than budgeted. • ($22k) due to annual leave taken• ($6k) annual leave revaluations

• Nursing 5: $ 3k.

geted • $30k due to FTE less than bud• $38k reversal of PTR accrual

g NMW accrual) • ($10k) pay rates greater than budgeted (includin• ($13k) annual leave taken less than budgeted.

• Psychol is

y Public Health Promotion / Protection Officers)

($10k) annual leave taken less than budgeted.

• Managemen ($5k) annual leave revaluation (being investigated)

ariance • Treatme D

• tivity in Maternity & NICU, and uneven purchasing patterns in Fertility and School Dental Services

• Diagnos S s). Even though purchases

de evenly, Fertility are over budget by ($20k) YTD in this area.

• Hotel Servicity.

• IT Systems & $9k general activity variances across the group.

og ts, Social & Community: $20k. • $20k FTE less than budgeted (mainl• $10k pay rates less than budgeted. •

t/Admin: ($10k). •

Other costs: ($26k) unfavourable vnt isposables: ($10k).

($10k) general activity variances across the group. Due mainly to ac

tic upplies: ($8k).

($10k) in Fertility Service (tissue culture media and other diagnostic supplie•are not ma

es: ($9k).

• ($6k) in Maternity due to activ

Telecommunications: $9k. •


• Profess a

($6k) Midwives Standards Review in Maternity greater than budgeted.

Dr Susa s Clinical Director Group Manager Nursing / Midwifery Director

ion l Fees & Expenses: ($9k). •

n Fleming/Dr John Holme Pip Stewart Debi Lawry / Jenny Woodley


diagnostic & support services group may 2007 1. service ...€¦ · diagnostic & support...

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