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UNIVANTS of Healthcare Excellence Award 2020
UNIVANTS, which stands for ‘unity’ and ‘avant-garde’ is a healthcare industry award that annually recognizes teams who collaborate across disciplines and transform healthcare delivery, and ultimately patient lives.
The awards were announced in Milan, Italy in 2020. The submissions included hospitals, commercial laboratories, reference laboratories, clinics and rural community care from over 140 countries. Applications included best practices across key areas of unmet needs with representation from every region of the world, spanning both emerging and established markets.
Martin Than says the project was set up as a rapid response in redesigning Canterbury DHB’s pathway processes for people with possible heart attacks being investigated at Christchurch Hospital.
Christchurch Hospital a facility within New Zealand’s Canterbury District Health Board, is well known for best practice approaches in the assessment of patients with suspected heart attacks. The Emergency Department Assessment of Chest Pain Score Accelerated Diagnostic Protocol (EDACS-ADP) developed by a multidisciplinary team co-led by Emergency Medicine Specialist Dr. Martin Than. It is widely used across Australasia to quickly and safely assess patients. Dr Than’s team is consistently exploring novel ways to improve.
The advent of the COVID-19 pandemic accelerated their important work to reduce the time at-risk patients spend in the ED, minimizing the risk of cross-infection and freeing up both ED and inpatient bed capacity for an expected influx of COVID-19 patients. Their new pathway involves cardiac troponin results combined with clinical risk and was derived using evidence-based patient outcomes. It aimed to reduce the number of patients who required serial troponin tests in the ED, as repeated testing prolongs length of stay in the ED.
The team devised three decision-making strategies which were dependent upon the predicted rate of a major adverse cardiac event (MACE). Patients with a single troponin result with less than a 1 percent chance of MACE could be discharged home. Patients with a single troponin result suggesting an approximate 1 to 5 percent chance of MACE could be discharged home with a second follow-up test to be done at a community clinic. Finally, patients whose troponin result suggests a higher than 5 percent chance of MACE would receive additional testing in the hospital. A process was also created for high-risk patients to be immediately assessed by the cardiology team without an extensive ED assessment, reducing duplication of care and expediting referral, which is often required in high-risk cases.
Significant discussion between clinicians was needed to agree upon these troponin thresholds and ensure clinician adherence. “Making any change can be difficult, but making change quickly is exceedingly challenging,” Than said.
Ultimately, implementation of this expedited pathway enabled a 45 percent increase in the number of patients safely sent home from the ED within two hours, and a 35 percent increase in those sent home within three hours. These phenomenal outcomes resulted in a 24 percent reduction in hospital admissions for patients with a diagnosis of unspecified chest pain. This process improvement allowed 55 percent more suspected heart attack cases to be ruled out with just one troponin result. This reduced the number of cardiac admissions that that were ultimately not diagnosed as a MACE by 8 % optimizing cardiac bed utilization. This reduction in bed and resource utilization enabled annual costs savings of $530,000 NZD a year.
“I’m very proud of the team for doing what we did, but I’m even prouder still for our history that allowed us to make such an effective, rapid and agile change in a time of necessity,” Than said.
Award winners Dr Jacques Loubser, Professor Chris Florkowski, Dr Martin Than, Professor John Pickering and Dr Sally Aldous
Rising from the Rubble
How do health care workers manage disaster on an unprecedented scale? The 2011 Canterbury earthquakes were more challenging to the region’s health system than anyone could have expected.
Rising from the Rubble has been written by Drs Mike Ardagh and Jo Deely and published by Canterbury University Press. It tells the story of the Canterbury Health System’s response to the 2011 earthquakes gives a compelling account of those who rallied to maintain and rebuild essential health services, maintaining continuity of care for the most vulnerable – from older people to those with kidney failure – as well as dealing with the significant ongoing impact on mental health.
Rising from the Rubble reveals the untold stories of local heroes. The book is based on interviews with those who lived and worked through the Canterbury earthquakes. The book covers the period from the immediate emergency response after the earthquakes to sustaining health services over the following years, in challenging circumstances. Rising from the Rubble also provides a record of how the injuries of the immediate aftermath gave way to a wave of quake-related surgical procedures over several weeks, through to the growth of long-term mental health issues over the years.
The Health System’s response was simply remarkable and this book contains a number of insights and new information which has never been shared publicly.
Professor Michael Ardagh and
Dr Joanne Deely