Against a backdrop of bushfire recovery and the emerging COVID-19 pandemic, emergency department (ED) and elective surgery activity in Northern NSW Local Health District remained high in the first quarter of 2020.
According to the latest Bureau of Health Information Quarterly Report, there was a 1.4 per cent increase in ED presentations, to 54,515, or 757 more people compared to the same quarter in 2019, as well as a 6.3 per cent increase in ambulance arrivals, up to 8,357.
During this quarter our EDs also saw a 7.2 per cent increase (to 238) in T1 presentations, the most urgent category.
Even with the increased activity and reallocation of staff and resources as part of the COVID-19 health response, NNSWLHD Chief Executive Wayne Jones said the emergency care provided at the District’s hospitals was consistently high-quality.
“For many of our team, this period would have been one of the most stressful in their careers,” Mr Jones said.
“Not only did we have to prepare quickly for a large COVID-19 outbreak, and the many operational changes that involved, we also maintained the high-quality care Northern NSW residents are accustomed to.
“According to this report, we are again one of the top rural Local Health Districts in the state when it comes to timeliness of care, and I could not speak more highly of our team of healthcare professionals.”
Across the NNSWLHD, 75.8 per cent of patients started treatment on time, which is above the state average, and 77.4 per cent of patients left the ED within four hours of presentation.
“The full scale of the impact of COVID-19 on activity and performance is hard to measure at this early stage, since there are many factors which have affected the way the community interacts with our services,” Mr Jones said.
“There have been significant leaps in take up of virtual models of care, changes to public gathering and personal hygiene practices, establishment of dedicated COVID-19 testing clinics and the temporary suspension of non-urgent elective surgery.
We must therefore use a cautious approach when comparing this quarter with previous quarters.”
ELECTIVE SURGERY PERFORMANCE
Due to COVID-19, there were major changes to elective surgery toward the end of this reporting period, with non-urgent elective surgery ceasing on 25 March, in line with the direction from National Cabinet.
Despite this change, total surgeries performed across the District increased by 1.6 per cent to 3,429, and there was an eight per cent drop in the number of patients on the waiting list at the end of the quarter, compared to the same period in 2019.
While the average wait time for patients requiring urgent elective procedures increased by three days to 13 days, wait time for semi-urgent procedures was reduced by a week to 50 days. In this quarter, 92.3 per cent of elective surgeries were completed on time, including 99.7 per cent of urgent procedures being completed within the clinically recommended timeframe.
The NSW Government has announced up to an extra $388 million will be invested to fast-track elective surgeries which were delayed as a result of the National Cabinet decision, ensuring they will be booked in to public or private hospitals as soon as possible.
NSW Health will host a roundtable with public and private health sectors and clinicians within the next month to determine if there are any additional measures the health system could employ to ensure elective surgeries and any other procedures occur as quickly and appropriately as possible.
Surgery lists are being closely monitored, and any patient whose condition changes or deteriorates should speak to their treating clinician. Clinicians determine the surgical priority of their patients.
The NSW Government has committed $800 million extra funding over two years on top of the 2019-20 Health Budget of $26.7 billion to help boost ICU capacity and purchase additional services and medical equipment, to help respond to COVID-19.
Ballina District Hospital ED saw a 2.2 per cent increase in presentations. Despite this increase, 74.1 per cent of patients started their treatment on time, and 80.7 per cent left the ED within four hours.
During this quarter, 8.2 percent more (or 15 more) elective surgeries were performed, with 93.1 percent of all surgeries performed on time.
Byron Central Hospital ED had a 2.6 per cent decrease in presentations (156 fewer). T1 and T2, the most urgent triage categories, were down by 23.5 and 13.9 percent respectively compared to the same quarter in 2019, while T4 and T5 presentations were both up by 11.4 percent (or 368 people in total). Byron Central Hospital saw an improvement in patients starting treatment on time (up to 80.2 per cent) and an improvement in the proportion of patients leaving the ED within four hours (up to 84.1 per cent).
Casino and District Memorial Hospital ED had a 2.5 per cent increase in presentations, up to 3,407. The hospital saw a notable increase in semi-urgent T4 presentations, which were up by 13.7 per cent to 1,664. Despite this increase, the proportion of patients starting their treatment on time improved to 72.8 per cent, and the proportion leaving within four hours also improved to 90.3 per cent. There was a 3.6 percent increase in elective surgery procedures performed, up to 174, with 98.7 percent of all procedures performed on time.
Grafton Base Hospital ED had a small increase in presentations (up 0.4 percent), and an 11.1 per cent increase in ambulance arrivals. 71.2 percent of patients started treatment on time, and 73.1 per cent of patients left the ED within four hours. Overall, in this quarter, 11 more elective surgeries were performed (up to 515), with 53 (or 33.5 percent) more semi-urgent procedures, while fewer urgent and non-urgent procedures were performed. Almost all surgeries (98.6 per cent) were performed on time.
Lismore Base Hospital ED saw 10,144 presentations, a significant increase of 8.0 per cent. There was a 17 per cent decrease in T1 presentations (nine fewer presentations), however there were increases in all other triage categories. During the quarter, 71.4 percent of patients started treatment on time, up 2.1 percentage points on the same quarter in 2019, and the median time to leave the ED improved by two minutes.
There were 1,269 elective surgeries performed, 1.8 per cent more compared to the same quarter in 2019, and 87.9 per cent of all surgeries were performed on time. At the end of the quarter, there were 295 fewer patients on the waiting list ready for care, a decrease of 15.7 percent compared to the same time in 2019.
Maclean District Hospital ED saw a decrease of 2.6 per cent in presentations, down 90 people to 3,388. The most notable decline was in T5 non-urgent presentations, which were down 40.8 per cent (or 159 fewer patients) to 231. There was a 10.5 per cent increase in T3 presentations, up 98 to 1,028. There was also an increase of 5.8 per cent in the number ambulance arrivals to the ED. However, 80.7 percent of patients left the ED within four hours.During the quarter, 14 fewer elective surgeries were performed, down to nine.
Murwillumbah District Hospital experienced a 9.3 per cent increase in ambulance arrivals, yet an overall decrease in ED presentations, down 2.6 per cent to 4,411. T1 presentations decreased by half to a total of five, however emergency, urgent, and semi-urgent presentations all increased. Despite this, 86.7 percent of patients left the ED within four hours. At Murwillumbah District Hospital there was an 18.5 percent (73) decrease in elective surgeries, down to 322, with 97.7 percent of all surgeries performed on time.
The Tweed Hospital saw a 9.7 per cent increase in ambulance arrivals and an overall one per cent increase in ED presentations, up to 13,627. T1 presentations doubled compared to the first quarter in 2019, and ED presentations were up across all five triage categories. Despite this increase, the median time to emergency T2 treatment only increased by one minute and was reduced in all other triage categories. Also, 80 per cent of patients started treatment on time, a 0.4 per cent improvement. Altogether, 942 surgeries were performed, an increase of 9.9 percent on Jan-March 2019, with a notable 94.9 percent increase in non-urgent procedures, up by 149 to 306. While achieving this increase, 91.2 percent of all procedures were performed on time.
Northern NSW LHD is committed to reducing and where possible, eliminating seclusion and restraint, and providing the best possible mental health care in the least restrictive environment.
During the January to March 2020 quarter, there were 399 acute mental health episodes of care across the district’s specialised mental health units, with 235 at Lismore and 164 at Tweed. The rate of seclusion at Lismore was 9.3 episodes per 1,000 bed days, above the NSW rate of 5.6 and NSW target of 5.1. The duration of seclusion was 3 hours and 18 minutes, below the target of four hours and also below the state average.
The rate of seclusion at Tweed was 1.7 per 1,000 bed days. The duration was not reported due to the low number of overall events and the need to protect patient privacy.
The rate of physical restraint events at Lismore was 10.3, above the NSW average of 7.0. The rate at Tweed was 7.2. The duration of physical restraint at Lismore was 3 minutes, which was 8 minutes less compared to a year ago, and also less than the NSW average of 5 minutes. Tweed was also below the NSW average at 1 minute.