from which 150 were randomly selected and analysed in a spreadsheet. The forms covered patients from a range of locations but did not include demographic details. In total, the qualitative experiences of 221 patients were gathered across the three methods. The demographic characteristics are summarised in Appendix 5. The potential limitations of the sample of telephone interviews should be noted. Time constraints meant that informed consent had to be sought via the 30-day patient follow-up call, and so this meant the sample was skewed to those with recent experiences. The sample was also skewed towards caregivers of children under the age 16 years, who formed 20/28 or 71% of interviewees. Furthermore, 18/20 of these children had received dental surgery. Nevertheless, we do not believe that the robustness of the interviews was compromised, given the consistency of the results with those obtained from the other two methods. : Sampling patient views – summary of sample sizes Indicator Patient telephone interviews Patient postal survey Patient feedback forms Sample size (n) 28 43 150 Response rate (%) 76% (28/37) 27% (43/162) 22% (150/690)1 Source: Sapere Research Group Not strictly a response rate; sampled from forms received by the provider over a 12-month period. Quantitative approaches Service volume analysis Data on the volumes delivered under the services was made available by MSS Ltd through an online portal. We analysed the data for patterns and trends. The key data elements identified for the mobile surgical service were: discharges by hospital site, health specialty and diagnostic-relating ( DRG); patient demographic information, including sex, age and ethnicity; patients who did not attend their surgical appointment (“no shows” or DNAs); and the number of surgical days per year. We used this data for a number of purposes, for example, to a picture of performance against contract and to inform our consideration of patient access to the mobile surgical service. To that end, we estimated the rate of “did not attends” for the mobile surgical bus and compared that with average rates across district health boards. We also considered whether the service helps to reduce health inequalities for Māori and Pacific peoples, by examining discharges by ethnicity and comparing the representation of those groups with their representation among estimates of the rural population.
Case study: An application of intubation training A senior medical officer who works at rural hospitals, and who regularly trains aboard the mobile surgical bus, recounted an occasion where those skills were used in an emergency. The situation A patient presented to the senior medical officer at the emergency department of [a hospital] on a Sunday evening. The patient was not feeling well, having recently had laser treatment on the vocal cords. I could hear that the patient had developed noisy breathing. The situation quickly deteriorated to the point where the patient could not breathe because of a swelling in the vocal cords following surgery and was lapsing into unconsciousness. The medical intervention It was apparent that the patient required an immediate intubation – insertion of an endotracheal tube to open the airway and enable ventilation. This invasive procedure typically requires anaesthesia. Before intubation, I had to take steps to sedate the patient using propofol and then administer medications to paralyse the patient so as to reduce any risk of vomiting. I then inserted the endotracheal tube to enable ventilation. The outcome By the time the patient was transferred to [a base hospital], the oxygen levels in the were normal and the patient was being ventilated. The patient remained in the intensive care unit for a couple of days before making a complete recovery. An ambulance came to the patient (as the rescue helicopter was unable to fly that evening due to weather conditions), but this took over hour and a half and the patient wouldn’t have survived without that procedure. The impact of the training The senior medical officer valued the opportunity to regularly assist aboard the mobile surgical bus as one way to help maintain these skills. My experiences on the bus meant I had more familiarity to competently and safely deal with the anaesthetic drugs involved and to take steps to stabilise the patient. For example, the drugs reduce blood pressure and so you think ahead to compensate to avoid cardiac arrest. It’s about having the skill to correctly place the tube in the airway. It’s not straightforward and you have to avoid the oesophagus. I teach Advanced Cardiac Life Support, but practicing on mannequins is not the same, as you can’t duplicate the anatomical nuances. This refresher experience is crucial, as you don’t deal with these situations frequently enough in smaller centres, but they do occur. So I value being able to access the bus.