This study audits the delivery and standards of New Zealand (NZ) inflammatory bowel disease (IBD) care against international standards, with emphasis on the IBD nursing role. Methods: Utilising international standards in IBD care, a 3 phase national multicentre survey study was performed between 2015 and 2019. We 1) evaluated the current role and practices of IBD nurses, 2) evaluated IBD service provision and identified areas for improvement, and 3) audited key aspects of IBD patient care, directly comparing nurse-led and doctor-led outpatient clinics. Results: The median duration spent in an IBD nursing role was 21 months (range 2 to 120 months) with the majority (12/15) performing two or more nursing roles. The median IBD nurse full-time equivalent (FTE) was 0.8 (range 0.2 to 1.25). The average number of hours spent undertaking IBD nursing tasks was 22.2-a 6.8-hour shortfall compared to rostered hours. No service had a per capita IBD multidisciplinary team (MDT) FTE which met international standards. Just under two-thirds (62.5%) of departments held a regular MDT meeting. All responding services could be contacted directly by IBD patients and respond within 48 hours of contact. During 492 doctor-led and 196 nurse-led scheduled outpatient clinic visits, nurses were significantly more likely to document weight, smoking status and organise appropriate colonoscopic surveillance than doctors. Conclusion: Multiple nursing job roles resulted in rostered hours being insufficient to complete IBD specific tasks. IBD FTE did not meet international standards. The IBD care was patient-centred, encouraging direct contact from patients with prompt response. IBD nurses in NZ provide high-quality outpatient care when measured against auditable standards. As the IBD nursing role continues to develop, following the implementation of an educational framework and education programme, an increase in numbers is required in order to achieve the recommended minimum FTE per 250 000 population.

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Background: Guidelines for acute coronary syndrome management advocate a 12-lead electrocardiogram should be taken en route and transmitted to prenotify the receiving medical facility. The aim is to obtain a door-to-balloon time (DTBT) <90mins. We sought to analyse the benefits of prenotification.Method: Excluding cardiac arrest, consecutive patients undergoing primary PCI for STEMI between 2011-2016 from the MIG registry were included with analysis separated into prenotified and non-prenotified groups.Results: 1134 prenotified (38.6%) and 1806 non-prenotified (61.4%) cases were compared. The prenotified group has a higher proportion of patients >75yo (29.0% vs 22.8%, p = 0.01) and have an eGFR<60 mL/min/1.73m 2 (28.2% vs 22.7%, p<0.01), but a similar cardiogenic shock rate (6.7% vs 5.2%, p = 0.12). The prenotified group has a higher thrombus aspiration use (30.2% vs 22.4%, p < 0.001), glycoprotein IIbIIIa inhibitor use (66.6% vs 53.4%, p < 0.001), RCA intervention (47.1% vs 36.5%, p < 0.001) and bare metal stent use (40.5%vs36.0%, p < 0.05) with similar procedural success (95.7% vs 95.2%, p = 0.54). Prenotification leads to a 36 min shorter DTBT (52mins vs 88mins, p < 0.001). Prenotification increases total DTBT < 90mins (88.9% vs 51.3%, p < 0.001), increases in hours DTBT<90mins (93.3% vs 61.6%, p < 0.001) and after hours DTBT < 90mins (85.6 vs 46.0%, p < 0.001). Prenotification has a higher in-hospital (4.6% vs 2.9%, p < 0.05) and 30-day mortality (5.1% vs 3.6%, p < 0.05). Prenotification is not an independent predictor for 30-day mortality (HR 1.37, 95% CI 0.91-2.07).Conclusion: Although prenotification dramatically improves DTBTs (especially after hours) and reduces total ischaemic time, early mortality is not lower. The effect on long term mortality after STEMI is eagerly awaited.

BackgroundAccess to individual percutaneous coronary intervention (PCI) centres has traditionally been determined by historical referral patterns along arbitrarily defined geographic boundaries. We set out to produce predictive models of ST-elevation myocardial infarction (STEMI) demand and time-efficient access to PCI centres.MethodsTravel times from random addresses to PCI centres in Melbourne, Australia, were estimated using Google map application programming interface (API). Departures at 08:15 and 17:15 were compared with 23:00 to determine the effect of peak hour traffic congestion. Real-world ambulance travel times were compared with estimated travel times using Google map developer software. STEMI incidence per postcode was estimated by merging STEMI incidence per age group data with age group per postcode census data. PCI centre network configuration changes were assessed for their effect on hospital STEMI loading, catchment size, travel times and the number of STEMI cases within 30 min of a PCI centre.ResultsNearly 10% of STEMI cases travelled more than 30 min to a PCI centre, increasing to 20% by modelling the removal of large outer metropolitan PCI centres (p<0.05). A model of 7 PCI centres compared favourably to the current existing network of 11 PCI centres (p=0.18 (afternoon), p=0.5 (morning and night)). The intraclass correlation between estimated travel times and ambulance travel times was 0.82, p<0.001.ConclusionThis paper provides a framework to integrate prehospital environmental variables, existing or altered healthcare resources and health statistics to objectively model STEMI demand and consequent access to PCI. Our methodology can be modified to incorporate other inputs to compute optimum healthcare efficiencies.

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