COVID-19 response by New Zealand general surgical departments in tertiary metropolitan hospitals.

BACKGROUND: Worldwide, coronavirus disease 2019 (COVID-19) has significantly challenged the delivery of healthcare. New Zealand (NZ) faced similar potential challenges despite being geographically isolated. Given the rapid change in the COVID-19 pandemic, hospitals in NZ were tasked with formulating their own COVID-19 responses based on the Ministry of Health's (MoH) recommendations. METHODS: This paper evaluates how six metropolitan general surgical departments in NZ had responded to COVID-19 in terms of changes made to rosters, theatres, clinics, acute admissions as well as additional measures taken to reduce the risk of staff exposure. It also explores how NZ fared in comparison with international guidelines and recommendations. Data from each centre were provided by an appointed clinician. RESULTS: All centres had adapted new rosters and a restructuring of teams. Handovers, multidisciplinary team meetings and educational sessions were held virtually. Different strategies were implemented to ration hospital resources and reduce the risk of staff exposure. Non-urgent operations, endoscopies and clinics were deferred with allocation of dedicated COVID-19 operating theatres. Potential COVID-19 suspects were screened prior to admission and treated separately. Various admission and imaging pathways were utilised to increase efficiency. CONCLUSION: General surgical departments in NZ had implemented a comprehensive COVID-19 response but there is room to work towards a more unified national response. Our analysis shows that these centres across NZ had taken a similar approach which was aligned with international practices.

The factors that lead to a delay between general practitioner referral of symptomatic patients and specialist diagnosis of colorectal cancer: an audit in the Bay of Plenty District Health Board.

AIM: To determine factors leading to delay between referral by the GP of symptomatic patients and subsequent specialist diagnosis of colon or rectum cancer (CRC). METHOD: A retrospective audit of patients with new CRC referred by their GP over a 30-month period to the specialist services. Analysis of referral letters, specialist grading and subsequent results of investigations. We focused on the High Index of Suspicion (HIS) criteria for suspected CRC. RESULTS: Only 65 out of 181 patients fulfilled the HIS criteria and of these only half were correctly identified in the referral letter. Only 48 who fulfilled HIS criteria were graded as urgent by the specialist and had their fast-track diagnostic test within a median of 21 days (5-114). The remaining 133 waited a median of 67 days (10-387) (p<0.001). The diagnosis was reached faster if the patient went straight to colonoscopy rather than initial outpatient assessment: median 32 versus 81 days (p=0.008). CONCLUSION: The HIS Urgent pathway only identified a third of patients and so the criteria should be reviewed. GPs frequently failed to recognise and refer those who met the criteria. A standardised referral form prompting the inclusion of all required information would improve this.