Problems with heart services at a major hospital have been linked toavoidable deaths, by a confidential report leaked to the Herald.
Waikato Hospital has sent cardiac surgery patients to other hospitals because of severe delays.
As part of that arrangement specialists from Auckland City Hospital were invited to Waikato Hospital, and in July last year delivered a troubling report.
That document has been provided to the Herald by a source concerned that the issues - some long-standing and severe - haven’t been properly addressed.
The Auckland specialists toured facilities and talked to staff. They restricted their report to their observations, to protect the confidentiality of those they interviewed, and because they didn’t have time to talk to everyone.
They found a combination of “resourcing challenges” (mostly insufficient workforce), “process issues” and “communication, trust and interpersonal issues”.
Some problems were long-standing and “relatively acute”, they warned. The specialists did not do an in-depth analysis of what was happening to patients but were worried.
“With the series of concerns raised and identified there is clearly a risk to patient outcomes,” they warned.
“At a minimum, there is wide recognition of poor patient experience and avoidable preoperative mortality.”
Like other hospitals, there are mortality and morbidity meetings — peer reviews of issues that occurred during a patient’s care, possibly contributing to a death or a complication.
“However, there is too much focus on individual cases, there is a lack of transparency and the meetings would benefit from a regular overall look at outcomes,” the specialists recommended.
In cardiology, overwhelming demand and vacancies meant clinicians struggled to have enough time with patients. Some cardiologists didn’t do any ward work, the report stated, and there was a perception that those who did had an “onerous” workload.
Wait times for echocardiograms, an ultrasound that checks the structure and function of the heart, were a particular concern.
In the related but separate cardiac surgery department, “significant frustration about communication and planning is evident”, the Auckland specialists wrote, with an ongoing dispute over conditions/pay, and no consensus about what procedures should be done.
High-risk patients are reviewed by a multidisciplinary group of doctors to decide on the next and longer-term treatment. However, at Waikato “this does not seem as systematic or patient-focused as it should be”.
There was a lack of visibility about who went on the surgical waitlist, “no clear ownership/system for inpatients”, and “no system for discharging and/or returning a patient to the home district hospital and keeping a clear line of sight of them/keeping their prioritisation.”
Severe staff shortages in Waikato’s intensive care unit (ICU) have fuelled cardiac surgery delays, and the Auckland specialists’ report found “questions around culture in ICU with regard to senior medical officer recruitment and retention”.
In comments about the overall situation, they said staff worked very hard, and senior hospital leaders grasped the issues, “but a clear plan for progressing successfully has not been able to be developed”.
There are only five hospitals in New Zealand that do cardiac surgery, and others have backlogs too — nationally, about one in two people needing heart surgery waited longer than the maximum time frame considered appropriate by their specialists.
Waikato Hospital heart services have been under serious strain. Photo / Alan Gibson
Were patients harmed? Waikato Hospital responds
Michelle Sutherland, Health NZ/Te Whatu Ora’s group director of operations for Waikato, said cardiothoracic and supporting services “continue to face ongoing high acute demand and staffing challenges”.
The discussion document by the Auckland specialists wasn’t a formal review, Sutherland said, “but is a useful tool and largely aligns with what we have identified internally and have been working to address.”
A “cardiothoracic improvement project group” has representatives from Waikato, Bay of Plenty and Auckland hospitals, and meets fortnightly.
Changes made include streamlining electronic referrals, establishing a cardiology leadership group, bringing together different multi-disciplinary meetings to improve focus on complex cases, and recruiting ICU staff.
Asked if patients have been harmed because of avoidable delays, Sutherland said, “across all healthcare services any delay in patient care has the potential to cause harm, either through the worsening of symptoms or extended time the patient has to manage symptoms”.
“This is why service improvement is an ongoing focus across all areas, at all times.
“Unfortunately, we do face high demand and the impacts of skills and staffing shortages globally, so teams are focused on doing as much as possible with our available resource, ensuring care is prioritised by clinical urgency, and we continue to recruit and work with other providers to utilise all available capacity.”
A doctor who works at Waikato Hospital, who asked to remain anonymous, told the Herald patients had suffered. Even if they are seen, it could take multiple staff meetings “of endless debate” before treatment is decided upon. In one such case the patient died soon after the unnecessary delay to his surgery, the doctor claimed.
“Yes, there is an ICU capacity issue but that is not the full story of the gross delay in cardiac surgery.”
Sutherland said without details it wasn’t possible to review the alleged case, “however, it is often appropriate for cases to have follow-up reviews if their condition or status changes and this occurs regularly.”
The Herald revealed the cardiac surgery overhaul at Waikato Hospital in a front-page article in April 2021.
History repeats: Waikato Hospital’s secret review of years-long problems
The findings were scathing, and described an understaffed and “broken system” that had contributed to “concerning outcomes for patients”.
Bullying and oppressive behaviour were “prevalent at all levels of the organisation”, the report found, with handling of cardiothoracic operating lists “grossly dysfunctional”.
As a result of the findings, the DHB – which said some of the review’s findings weren’t backed by evidence – undertook a two-year overhaul of its cardiac surgery service including hiring more staff and changes to improve teamwork, governance and leadership.
Some of the problems identified in the 2018 review – such as culture, rostering, management of wait lists and a lack of transparency – are also features of the Auckland specialists’ report.
The experts had not read the 2018 review but stated “it would be helpful however to compare our recommendations to those made in 2018″.
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