Not just an Auckland hospital: Starship by the numbers

We need you to help us to Help Our Kids. The Herald is running a major campaign to try and raise at least $150,000 for our national children’s hospital, Starship. Each year, more than 9000 Kiwi kids from right throughout the country are treated in Starship’s theatres. Now it’s our turn to help the hospital and staff that Help Our Kids.

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Children from outside Auckland make up nearly 16 per cent of the patients admitted to Starship.

Some come by ambulance but some, the children suffering a life-threatening injury or illness, are flown by Starship's national air ambulance service and cared for on the journey by the hospital's own medical staff.

Patients from outside the Auckland region comprised nearly 4000 of the 24,224 admissions to the hospital last year.

This helps to explain Starship's overlapping roles as the children's hospital for central Auckland, for the Auckland region, for New Zealand and even, in a relatively small number of cases, for the Pacific Islands.

It is a local hospital for routine "secondary level" treatment, a regional hospital for "tertiary" care and a national - and international - facility for the most complex kinds of treatment.

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And this makes the public appeal for help with fixing up Starship's old operating theatres a national one, because although patients from outside Auckland are the minority, they are on average more complex cases who stay in hospital for longer.

It was complex care - neurosurgery - that brought Toby to Starship. Paediatric neurosurgery is among about 40 departments and units run from Starship or connected to services at the adjacent adults' hospital.

Where Starship's patients come from (% of patients)

Services for which Starship is the national children's centre include heart surgery and liver transplants. It is the national referral centre for children with complex health needs who may require spinal surgery. The neurosurgery department covers the upper half of the North Island.

Starship's former clinical leader Dr Richard Aickin, a paediatric emergency department specialist, said many of its divisions, such as respiratory services and gastroenterology had local as well as national aspects. For instance, paediatricians all over the country treated epilepsy, but surgery for epilepsy that did not respond to other therapies was only done in Auckland.

Percentage of admissions by age group

Likewise with cancer, the more complex tumour cases were managed from Starship. Bone marrow transplants were meant to be divided between Christchurch and Auckland, but Auckland was doing a much greater proportion of them than planned because of the southern earthquakes.

The connecting link for many of these complex cases, whether their surgery was in Starship's own theatres or in Auckland City Hospital next door, is the paediatric intensive care unit (PICU), where many of the patients go after surgery. This is a national service for children requiring intensive care for more than 24 hours and a regional service for those needing intensive or high-dependency care. More than half of its 1200 patients a year come from outside the Auckland region.

Facts and Statistics (January-December 2013)

"About 40 per cent of the children admitted to PICU come directly from the operating theatres," said the unit's clinical director, Dr John Beca.

Most children who have heart surgery go to PICU afterwards, as do many orthopaedic surgery patients, especially those having spinal operations, and others including many having airway, chest or abdominal surgery.

Dr Beca estimates that around 10 per cent of PICU patients go to theatre for various kinds of procedures, such as having a bronchoscope - a telescope plus internal instruments - slid into their airway for investigation or treatment in the lungs.

"Unfortunately, in New Zealand we have a very high rate of skin and soft tissue infections. Sometimes that gets into the blood and bones. Children who come in with an infection that's got into their bone often go repeatedly back to the operating room for surgery to clear the infection ... to have the infection cleaned out.

"There's pus in the joints or bones. If it's in the joints they wash it out, if it's in the bones they clean the infection out."

PICU is located on a "hot floor" - the same level as the children's emergency department, the operating theatres, and the corridor and link to the helipad on top of a hospital carparking building. "We run a national retrieval service to collect children from around the country," said Dr Beca. "They come by ambulance or by air [helicopter or fixed-wing plane] if they are from out of Auckland."

The retrievals involve sending PICU staff to stabilise the child and bringing them back to Starship: more than 320 patients a year.

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