NEW ZEALAND 2016 JESSICA HUFF

Transcription

1 NEW ZEALAND 2016 JESSICA HUFF

2 NEW ZEALAND BACKGROUND Two islands: North & South Capital: Auckland Population: 4,673,659 60% located in Auckland

3 HOSPITAL BACKGROUND Publicly funded research and teaching facility Ran by Auckland DHB 3,500 rooms, 710 beds Treats 47,000 patients annually Auckland City Hospital

4 CCU BACKGROUND 22 beds (private and double bed rooms) Acute MI transfers from all remote hospitals ACS and Acute MI admissions are increasing Smoking, HTN, Maori descent are most common causes

5 CLINICAL EXPERIENCE Mr. M: 81yo Maori male transferred to Auckland city hospital with suspected infective endocarditis History of an aortic valve and aortic root replacement, type II diabetes, and two prior AMIs Accompanied by his daughter, who appeared mistrustful of the advice provided by cardiologists Mr. M underwent two TEE procedures First showed a possible vegetation but was inconclusive

6 CLINICAL EXPERIENCE Mr. M s repeat TEE was complicated by an esophageal tear and subsequent bleeding He required intubation, transfusion, pressors, and transfer to the CVICU for several days After stabilization and transfer back to the CCU, his daughter inquired about who had performed the second TEE procedure, and why it was required The physician explained the reason for both procedures, and named the cardiologist who had performed the repeat TEE After leaving the room, I asked my preceptor what she could do with the requested information

7 TOPIC OF INTEREST: HEALTH CARE COMPLAINTS After discussing the difficulties of the clinical case, many questions were left unanswered Interviewed preceptor regarding protocols for handling complaints

8 HEALTH CARE COMPLAINTS No monetary lawsuits against physicians Complaints filed with Health and Disability Commissioner or the Medical Council Objective is to handle complaint at lowest appropriate level Publicly funded by the registration and practice fees paid by all practicing doctors in New Zealand

9 HEALTH CARE COMPLAINTS Interventional Strategies: Individual: HDC encourages discussion with the physician, if possible, prior to filing a complaint Community: anyone can file a complaint, including a family member or health care professional representing the patient s best interest System: Committees in place to handle complaints in standardized fashion

10 HEALTH CARE COMPLAINT COMMITTEES Health and Disability Commissioner (HDC): handles complaints from a patient or health consumer Medical council: handles complaints raised by a doctor or other health professional about another doctor Professional Conduct Committee (PCC): handles complaints referred from HDC and with referrals after court convictions Performance Assessment Committee (PAC): handles complaints referred by anyone, considers competence of physician to continue to practice medicine

11 OUTCOMES OF HEALTH CARE COMPLAINTS HDC: Referral Medical council, PCC, PAC, or police An educational letter to the doctor Dismissal of investigation PCC: Review doctor s competence, fitness to practice medicine, and/or scope of practice Counsel doctor PAC: Doctor required to undertake a competence program Conditional requirements placed on scope of practice Additional exams taken or supervision required Interim suspension

12 LIMITATIONS Long process to file complaint Can be referred to several committees prior to resolution Prohibitive to patients with poor health literacy No patient reimbursement Health care costs are paid for by tax dollars Tends to favor physicians unless gross negligence is proven or documented More streamlined process to handle specific types of complaints?

13 CULTURAL EXPERIENCE: MAORI Indigenous inhabitants of NZ prior to European settlement in early 1800s 14% of NZ population Distrustful of physicians and government Overall poor healthcare Earlier CAD, high rates of CVD

14 PIHA BLACK SAND BEACH

15 BOATING IN BAY OF ISLANDS

16 BAY OF ISLANDS

17 REFERENCES Publications/Councilsprinciplesforassessmentandmanagementofcomplaintsa ndnotifications.pdf