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Issue

Vol 124 No 1342: 09 September 2011

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Issue Summary

SUMMARY

The financial impact of clinical task substitution between practice nurses and GPs in New Zealand primary care centres

Martin Hefford, Tom Love, Jacqueline Cumming, Mary Finlayson, Antony Raymont

The proportion of general primary care consultations undertaken by nurses varied from 4% to 46% of total recorded consultations. The actual financial impact for a practice owner of substituting more nursing time for GP time is highly dependent on the following variables: nurse cost per minute relative to GP cost minute; nurse consult duration relative to GP consult duration; nurse consult revenue relative to GP consult revenue; and the proportion of nurse consults also requiring GP time. Practice nurses can, and in some practices in NZ, do provide a broad set of primary care services, including undifferentiated general consultations. For some practices, increasing the proportion of nurse consults and reducing GP consults, would result in significantly improved profitabilityfor others, the opposite applies. Clinical task substitution (having nurses perform clinical tasks currently performed by doctors) is one option to address the forecast increase in demand associated with population ageing.

SUMMARY

Society’s expectation of the role of the doctor in New Zealand: results of a national survey

Andrew Old, Brandon Adams, Peter Foley, Harvey D White

In order to understand the perceptions of the New Zealand public as to the role of the doctor in 2010 a telephone survey of 502 individuals throughout New Zealand was undertaken.

SUMMARY

Communication difficulties with limited English proficiency patients: clinician perceptions of clinical risk and patterns of use of interpreters

Ben Gray, James Stanley, Maria Stubbe, Jo Hilder

Medical staff in hospitals in the two Wellington area District Health Boards were surveyed about their use of interpreters when treating patients with limited English skills. A small number were also interviewed about an actual consultation with such a patient. A high percentage reported being aware of how to obtain an interpreter and what the DHB policy was and felt that language difficulties had significant effects on care. However, there was wide variation in their reported actual use of interpreters, and there was no use of professional interpreters in the actual consultations studied, despite staff acknowledging increased clinical risk. Awareness of the issues is clearly not enough to ensure high levels of interpreter use and more needs to be done to increase this to ensure an equitable level of care for patients with limited English language.

SUMMARY

Compliance and quality in administration of a Surgical Safety Checklist in a tertiary New Zealand hospital

Nicole Vogts, Jacqueline A Hannam, Alan F Merry, Simon J Mitchell

A previous international study (in which Auckland City Hospital participated) showed that a safety checklist administered at 3 points during an operation reduced the collective rates of death and complications during surgery and in the post-operative period. A tailored version of this checklist has now been adopted by many NZ hospitals. We audited the administration of this checklist during 100 operations conducted at Auckland City Hospital. Many checklist items (and notably those relating to patient identity, the operation being performed and the site / side of the procedure) were administered in the vast majority of cases, but some checklist items were administered less consistently. Of most concern was the finding that the 3rd administration of the checklist ( csign out d), which should occur prior to the patient leaving the operating room, was not being done in the majority of cases. The effect of this omission on patient outcomes is not known. Engagement of operating room team members in the process of checklist administration was another area in which there is potential for improvement.

SUMMARY

Improving clinician-patient communication of health risks when diagnostic test information is imprecise

John Fountain, Philip Gunby

Both clinicians and patients experience difficulty with the statistical reasoning required to make inferences about health states on the basis of information derived from diagnostic tests. This problem will grow in importance as we move into the era of personalised medicine where an increasing supply of imprecise diagnostic tests meets an increasing demand to use such tests on the part of intelligent but statistically innumerate clinicians and patients. We describe a user-friendly, interactive, graphical interface for calculating, visualising, and communicating accurate inferences about uncertain health states when diagnostic information (test sensitivity and specificity, and health state prevalence) is imprecise and ambiguous in its application to a specific patient. The software is free, open-source, and runs on all popular PC operating systems (Windows, Mac, Linux).

ALL ARTICLES
SUMMARY

Magnetic Resonance Imaging (MRI): keeping abreast of current use

Paul Samson, Richard Harman, Richard Beedie, Michael J Baker

The financial impact of clinical task substitution between practice nurses and GPs in New Zealand primary care centres

Martin Hefford, Tom Love, Jacqueline Cumming, Mary Finlayson, Antony Raymont

On a New Method of Treating Cleft Palate: part 2

Society’s expectation of the role of the doctor in New Zealand: results of a national survey

Andrew Old, Brandon Adams, Peter Foley, Harvey D White

Use of pricing and tax interventions for protecting health: potential relevance for New Zealand of recent international developments

Nick Wilson, George Thomson, Tony Blakely

A cerebral mass in a patient with Churg Strauss syndrome

Nazish Ilyas, Christos Fountzilas

Laboratory diagnosis of factitious disorder: a systematic review of tools useful in the diagnosis of Munchausen’s syndrome

Christopher A Kenedi, Kristen G Shirey, Mary Hoffa, Joseph Zanga, Jonathan C Lee, Jeremy D Harrison, Xavier A Preudhomme

Communication difficulties with limited English proficiency patients: clinician perceptions of clinical risk and patterns of use of interpreters

Ben Gray, James Stanley, Maria Stubbe, Jo Hilder

Is integrated academic clinical training needed in New Zealand?

Michael Keogh

Compliance and quality in administration of a Surgical Safety Checklist in a tertiary New Zealand hospital

Nicole Vogts, Jacqueline A Hannam, Alan F Merry, Simon J Mitchell

Proceedings of the 208th Scientific Meeting of the Otago Medical School Research Society, Wednesday 24 August 2011

Improving clinician-patient communication of health risks when diagnostic test information is imprecise

John Fountain, Philip Gunby

Encapsulating peritoneal sclerosis—a complication of peritoneal dialysis

Caroline Chembo, Alastair Macdonald, Nicola Hay, Phillip Matheson, Grant Pidgeon, Murray Leikis

Imaging of the thyroid gland

Amirala Khalessi, Kim-Chi Phan-Thien

Medical image. Reversible knuckle hyperpigmentation in B12 deficiency

Vivek Kumar, Vishal Sharma

SUMMARY

The financial impact of clinical task substitution between practice nurses and GPs in New Zealand primary care centres

Martin Hefford, Tom Love, Jacqueline Cumming, Mary Finlayson, Antony Raymont

The proportion of general primary care consultations undertaken by nurses varied from 4% to 46% of total recorded consultations. The actual financial impact for a practice owner of substituting more nursing time for GP time is highly dependent on the following variables: nurse cost per minute relative to GP cost minute; nurse consult duration relative to GP consult duration; nurse consult revenue relative to GP consult revenue; and the proportion of nurse consults also requiring GP time. Practice nurses can, and in some practices in NZ, do provide a broad set of primary care services, including undifferentiated general consultations. For some practices, increasing the proportion of nurse consults and reducing GP consults, would result in significantly improved profitabilityfor others, the opposite applies. Clinical task substitution (having nurses perform clinical tasks currently performed by doctors) is one option to address the forecast increase in demand associated with population ageing.

SUMMARY

Society’s expectation of the role of the doctor in New Zealand: results of a national survey

Andrew Old, Brandon Adams, Peter Foley, Harvey D White

In order to understand the perceptions of the New Zealand public as to the role of the doctor in 2010 a telephone survey of 502 individuals throughout New Zealand was undertaken.

SUMMARY

Communication difficulties with limited English proficiency patients: clinician perceptions of clinical risk and patterns of use of interpreters

Ben Gray, James Stanley, Maria Stubbe, Jo Hilder

Medical staff in hospitals in the two Wellington area District Health Boards were surveyed about their use of interpreters when treating patients with limited English skills. A small number were also interviewed about an actual consultation with such a patient. A high percentage reported being aware of how to obtain an interpreter and what the DHB policy was and felt that language difficulties had significant effects on care. However, there was wide variation in their reported actual use of interpreters, and there was no use of professional interpreters in the actual consultations studied, despite staff acknowledging increased clinical risk. Awareness of the issues is clearly not enough to ensure high levels of interpreter use and more needs to be done to increase this to ensure an equitable level of care for patients with limited English language.

SUMMARY

Compliance and quality in administration of a Surgical Safety Checklist in a tertiary New Zealand hospital

Nicole Vogts, Jacqueline A Hannam, Alan F Merry, Simon J Mitchell

A previous international study (in which Auckland City Hospital participated) showed that a safety checklist administered at 3 points during an operation reduced the collective rates of death and complications during surgery and in the post-operative period. A tailored version of this checklist has now been adopted by many NZ hospitals. We audited the administration of this checklist during 100 operations conducted at Auckland City Hospital. Many checklist items (and notably those relating to patient identity, the operation being performed and the site / side of the procedure) were administered in the vast majority of cases, but some checklist items were administered less consistently. Of most concern was the finding that the 3rd administration of the checklist ( csign out d), which should occur prior to the patient leaving the operating room, was not being done in the majority of cases. The effect of this omission on patient outcomes is not known. Engagement of operating room team members in the process of checklist administration was another area in which there is potential for improvement.

SUMMARY

Improving clinician-patient communication of health risks when diagnostic test information is imprecise

John Fountain, Philip Gunby

Both clinicians and patients experience difficulty with the statistical reasoning required to make inferences about health states on the basis of information derived from diagnostic tests. This problem will grow in importance as we move into the era of personalised medicine where an increasing supply of imprecise diagnostic tests meets an increasing demand to use such tests on the part of intelligent but statistically innumerate clinicians and patients. We describe a user-friendly, interactive, graphical interface for calculating, visualising, and communicating accurate inferences about uncertain health states when diagnostic information (test sensitivity and specificity, and health state prevalence) is imprecise and ambiguous in its application to a specific patient. The software is free, open-source, and runs on all popular PC operating systems (Windows, Mac, Linux).

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