Heart and circulatory diseases are the commonest cause of death in New Zealand, accounting for approximately 40% of all deaths. A heart attack is a common cause of death, with 17 New Zealanders dying each day. Cardiac services can significantly improve patients outcomes if new treatments, available especially over the last 5 to 15 years, are available. The 2nd National comprehensive Cardiac Society Audit, run by busy Senior Doctors and Nurses have shown in 2002 and now again in 2007 that significant limitations exist at present. Improvements are needed, based on a 'Hub and Spoke' service, from each of the 5 Regional centres, with significant guidance and input from current clinicians: senior Doctors and Nurses who understand the complexities of Healthcare, and can improve on the current, fragmented service.

This is the second of 2 papers reporting on the 2nd National comprehensive Cardiac Society Audit, run by busy Senior Doctors and Nurses, which has shown in 2002 and now again in 2007 that significant limitations exist in the management of patients' who present with a heart attack or unstable angina to a New Zealand hospital. This paper focuses on the time delays experienced by patients who 'wait' for tests and treatments; the delays are significantly worse for patients admitted to a 'Non-Interventional' (mainly rural) Centre. Improvements are needed, based on a 'Hub and Spoke' service, from each of the 5 Regional centres, with significant guidance and input from current clinicians: senior Doctors and Nurses who understand the complexities of Healthcare, and can improve on the current, fragmented service.

The enhanced recovery after surgery programme (ERAS) is a clinical pathway that has been implemented to improve patient recovery after colonic surgery. We compared the costs involved to put 50 patients through this programme, with the costs incurred in 50 historical controls. We identified a significant cost saving as a result of ERAS implementation, even when implementation costs are taken into account.

Women with HIV infection have an increased risk of cervical cancer. It is recommended that women with HIV infection receive yearly cervical smears. Only 56% of women with HIV infection who were seen by the Infectious Diseases and Sexual Health Services at Auckland City Hospital had received a yearly cervical smear. It is very likely that seven women in this audit had undiagnosed HIV infection at the time of their first abnormal cervical smear. Health professionals performing cervical smear tests should consider offering an HIV test to all women with an abnormal cervical smear who have resided in areas with high rates of HIV infection.