Download The Lighthouse Project in Practice

The Lighthouse Project
Team:
A/Prof Jayme Bennetts; Prof Rob Baker;
Daphne Perry; Bronwyn Pesudovs
We would like to acknowledge and pay respect to the traditional owners
of the land on which we meet – the Kaurna people of the Kaurna Nation. It
is upon their ancestral lands that this facility is built.
The Lighthouse Project
The Lighthouse Hospital Project:
A joint initiative of the Heart Foundation and
the Australian Healthcare and Hospitals
Association (AHHA), funded by the
Australian Department of Health to improve
the Aboriginal and Torres Strait Islander
(ATSI) People’s pathway through hospital
when presenting with Acute Coronary
Syndrome.
Background
The Lighthouse Project casts a spotlight on the
leading cause of death for Aboriginal and Torres
Strait Islander peoples with 60 per cent likely to die
from coronary heart disease.
Evidence suggests Aboriginal and Torres Strait
Islander peoples experience rates of coronary
events, such as heart attack, 3 x higher than nonIndigenous Australians.
Background
20% of Cardiac Surgery at FMC
FMC performs 30% of Aboriginal and
Torres Strait Islander peoples Cardiac
Surgery in Australia
Patients come from Northern
Territory, Torres Strait Islands and SA
Relationship with Royal Darwin and
Alice Springs Hospitals and
surrounding communities.
Patients can travel up to 7,800 kms
return
In 2002 Northern Territory had highest
RHD incidence in the world.
Malcolm McDonald, NT Disease Control Bulletin Vol.10, No.2, June 2003
Background
Aboriginal and Torres Strait Islander patients:
 26 times higher rate of rheumatic fever
 20 times more likely to die in hospital with RHD
 45 % will receive heart valve surgery at age less than 25 years, compared
with 4% of non-Indigenous Australians
 Will return 2 or 3 times for repeat valve surgery
Jonathan R Carapetis, Alex Brown, Nigel J Wilson and Keith N Edwards Med J Aust 2007; 186 (11): 581-586.
Hospitalised with Acute Coronary Syndrome
 Double in-hospital coronary heart disease death rate
 40 % lower rate of angiography, coronary angioplasty or stent
procedures
 20 % lower rate of coronary artery bypass surgery
 7 times higher rate of death for 25-34 year-olds from heart disease
45% of Aboriginal men and 34% of women
die before the age of 45
Australian Institute of Health and Welfare (AIHW)
Case Study
Louise, 24 year old, rheumatic heart disease, first
presented to us in 2006 at 14 years of age for open
heart surgery for a mitral valve repair.
10 years later represented for mitral valve
replacement and tricuspid valve repair.
Because she wants children, warfarin is not
recommended, so she had a tissue valve inserted.
We will likely see
her return in 6-10
years time.
Presented with permission from Louise Brown, Patient,
Lighthouse Project
Lighthouse Project Action Plan
ACTION: Ensure Aboriginal and Torres Strait
Islander patients are better informed and
better prepared for surgery prior to travel.
Aim: Improve patient journey for Aboriginal and Torres
Strait Islander patients undergoing Cardiothoracic
Surgery at Flinders Medical Centre.
Domain: Clinical Quality
Improvement Objective: Impact
the patient journey prior to
admission, during hospitalisation
and after discharge.
Challenges Identified:
Travel – flights, appointments
Escort – availability, health
All surgery screening requirements – Echo, Angio,
dental checks, monitor infections, ceasing medications
prior to travel
Cultural Obligations – planning surgery around family
events Discharge planning - started early, often with
referrals prior to surgery (i.e., Heart Failure Unit at RDH)
Meeting transport needs - not only for discharge but
follow-up appointments
Patient review and follow-up prior to returning to
remote community
Discharge medications - in format/number to assist
with compliance
Prevention of complications by ensuring education
Addressing Challenges: Staff
understanding and cultural awareness
Aboriginal and Torres Strait Islander Patient Care Guidelines/
‘Sad News, Sorry Business’ booklets for staff working in SALHN.
Topics include providing culturally safe care, communication
aspects of clinical care, i.e., pain management and end of
life care.
Addressing Challenges:
Staff Cultural Awareness
Top Ten Tips Poster, laminated handout
Addressing Challenges:
Cultural Awareness/Communication
Aboriginal Liaison Officers from FMC’s Karpa Ngarrattendi
trained in cardiac and intensive care procedures as well as
in-case note documentation.
Addressing
Challenges:
Waiting List
Management
Change to cardiac
surgical waiting list
pathway to reduce
time remote patients
wait for cardiac
surgery.
A date of three months
from time of referral as
our current goal.
CONSULT
PREPARATION
TRAVEL
SURGERY
Addressing Challenges:
Patient Understanding
An Aboriginal and Torres Strait Islander Your Hospital Journey
booklet.
Addressing Challenges:
Patient Involvement and Understanding
A patient welcome package including:
• Tote bag
• Toiletries
• Your Hospital Journey booklet
• Map of Adelaide Hostels
• Rights and Responsibilities booklet
• Magnet
• Pen
Feedback has been very positive
Lighthouse and beyond – Phase III
Aboriginal Health Worker as part of CTSU/ICCU
staff (Cardiac/ICCU see approx. 30% of all ATSI FMC patients).
Cultural Safety/Cultural Competency online
training course
New Cardiac Surgery Unit with dedicated rooms
and meeting area
Thank you