19 Apr 2021 | Perioperative Mortality Review Committee
The Perioperative Mortality Review Committee (POMRC) is calling for district health boards (DHBs) to conduct an in-depth review into all cases of major trauma resulting in hospitalisation in Māori aged 15–18 years.
The recommendation comes from the POMRC’s ninth report, published today, which found that Māori youth aged between 15 and 18 years were three times more likely to die in the 30 days following major trauma than non-Māori in the same age group.
The POMRC reviews deaths related to surgery and anaesthesia that take place within the 30 days following an operation. It advises the Health Quality & Safety Commission on how to reduce these deaths and makes recommendations to make surgery safer for patients.
The ninth report focuses on comparing what happened (‘outcomes’) to Māori and non-Māori patients who were hospitalised following major trauma.
The report found that Māori were 37 percent more likely than non-Māori not to get an initial CT scan and 56 percent more likely to die in the first 30 days following major trauma that did not involve serious traumatic brain injury.
POMRC member Dr Dick Ongley says the report’s recommendations aim to help improve understanding of the factors that contribute to inequities in outcomes in the New Zealand health system.
‘We hope to help identify where the health sector can deliver better outcomes for Māori following major trauma.’
The report recommends Te Hononga Whētuki ā-Motu, the National Trauma Network, develops a national consensus guideline on prioritising CT scans for trauma cases to ensure unconscious bias and institutional racism do not result in inequitable health outcomes for Māori.
It also recommends DHBs review all cases of people with serious traumatic brain injury treated at non-neurological centres. The report recommends the reviews focus how appropriate and effective decisions about whether to transfer patients were.
The report also recommends all cases of trauma in Māori aged 15–18 also be reviewed to ensure key points of intervention were optimal and timely.
‘The reviews should consider the role implicit bias and institutional racism play in producing the inequities found and detailed in the report,’ says Dr Ongley.
‘There is a wide and established body of evidence about how unconscious bias and institutional racism in our health care system impacts Māori. Our report hopes to help those involved in the sector examine their own systems to improve trauma outcomes for Māori. Addressing this means linking trauma care to wider equity efforts
in the sector, including educating providers and recognising how crucial equity is to providing good-quality health care,’ says Dr Ongley.
The report recommends the Accident Compensation Corporation (ACC) provides extra resources to enable the New Zealand Major Trauma Registry to collect data on people who die from major trauma at the site of injury or on the way to hospital.
The report says robust and up to date information about outcomes for those who die from major trauma before reaching hospital is required to allow for more comprehensive reporting and support the development of robust public health policies.
The full report and summary version can be downloaded here: Equity in outcomes following major trauma among hospitalised patients.
E mea atu ana te Komiti POMR (Perioperative Mortality Review) kia whakamahia e ngā Poari Hauora ā-Rohe (DHBs) he arotakenga hōhonu ki ngā āhuatanga ngaukino nui katoa e hōhiperatia ai te Māori 15–18 tau te pakeke.
Ka ahu mai tēnei tohutohu i te pūrongo tuaiwa a te Komiti POMR e pānuitia ana i tēnei rā, ki roto nei e kitea ai mō te taiohi Māori i waenga i te tau 15 ki te 18 tau te pakeke ka toru tāima te tokomaha atu ka mate i te taiohi ehara i te Māori ki roto ki te 30 rā whai muri i tētahi ngaukino nui.
Ko tā te Komiti POMRC he arotake matenga ka meatia i te pokanga me te rehunga nō roto mai o te 30 rā whai muri i tētahi pokanga. Ko tā te Komiti anō he tohutohu i te Kupu Taurangi Hauora o Aotearoa me pēhea e whakaiti iho ai i ēnei tū matenga me te tohutohu atu anō e haumaru ai ngā pokanga mā ngā tūroro.
Ka aro atu te pūrongo tuaiwa kia whakataurite i te tūroro Māori ki te tūroro ehara i te Māori ina hōhiperatia whai muri i tētahi tūāhua ngaukino nui.
I kitea i te pūrongo mō te Māori, ka 37 ōrau neke atu i te tangata ehara i te Māori e kore pea e whiwhi he mātai CT tuatahi, ā, e 56 ōrau neke atu i te tangata ehara i te Māori ka mate pea i ngā rā 30 whai muri i tētahi ngaukino nui atu i tētahi tino wharanga roro.
Ka kī mai a Tākuta Dick Ongley mema o te Komiti POMR ko tā te pūrongo whāinga he āwhina atu kia piki te mārama ki ngā tino take e rerekē ai te mana taurite o ngā otinga i te pūnaha hauora o Aotearoa.
‘Ka tūmanako mātou kia tautohu ki hea whakapai ake ai i ngā otinga a te rāngai hauora mā te Māori whai muri i tētahi ngaukino nui.’
Kei te pūrongo he tohutohu ki Te Hononga Whētuki ā-Motu kia whakawhanakehia he aratohu whānui ā-motu hei whakaraupapa i ngā mātai CT kia kore ai te hinengaro rītaha me te kaikiri ā-whakanōhanga e awe i te mana taurite o ngā otinga hauora mā te Māori.
He tohutohu anō ki ngā Poari Hauora ā-Rohe ki te arotake i ngā take mō ngā tāngata ka pāngia ki tētahi tino wharanga ā-roro ka manaakitia i tētahi wāhi ehara mō te wharanga ā-roro. Ka kī mai te pūrongo kia arotahi atu ngā arotakenga e kitea ai ina tika rānei ngā whakatau kia whakawhiti tūroro.
He tohutohu anō hoki mō ngā take ngaukino o ngā Māori 15 ki te 18 tau te pakeke me arotake e kitea ai ina tino arotau ngā wā tauwhiro ina tere hoki te urupare.
‘Me whakaaroaro hoki ngā arotakenga ki te mahi a te rītaha pū me te kaikiri ā-whakanōhanga hei whakanao i ngā rerekētanga ka kitea i te pūrongo,’ ko tā Tākuta Dr Ongley.
‘He taunakitanga whānui, taunaki totoka hoki mō te pēhea e kaha pānga atu ai te rītaha hinengaro me te kaikiri o te pūnaha hauora ki te Māori. Ko te tūmanako o tā mātou pūrongo kia āwhinatia ngā kaimahi o te rāngai hauora ki te āta tirotiro i ā rātou ake pūnaha hei whakapai ake ngā hua ngaukino nui mā te Māori. Mā te tirotiro ka honohono te maimoa ngaukino ki ngā mahi mana taurite whānui o roto o te rāngai, tae atu ki te whakamōhio atu i ngā kaiwhakarato mō te tino mahi a te mana taurite hei whakarato maimoa hauora tino kounga,’ ko tā Tākuta Dr Ongley anō.
He tohutohu anō ki Te Kaporeihana ACC kia whakaratohia ngā rauemi atu anō e taea ai e te Rēhita Ngaukino Nui o Aotearoa te kohikohi ngā raraunga mō ngā tāngata i mate ai i te ngaukino nui i te wāhi i whara ai, i te haerenga atu rānei ki te hōhipera.
E mea ana te pūrongo me mātua whakaputa he kōrero o te wā tonu mō ngā hua mō ngā tāngata ka mate i te ngaukino nui i mua i te taenga atu ki te hōhipera e āhei ai ngā pūrongo tūturu te whakaputa me te tautoko i te whakawhanake i ngā kaupapa here hauora tūturu.
Ka taea te pūrongo katoa me te mea whakarāpopoto te tiki atu i konei: Te taurite o ngā hua i muri mai i te whētuki nui ki waenga i ngā tūroro hōhipera.
For a definition of major trauma we use the Major Trauma Network definition: “Trauma to patients suffering physical injury as a result of energy transfer (such as from a car crash) and not internal pathologic processes (such as a disease), with an Injury Severity Score (ISS) of 13 or more”. The Injury Severity Score (ISS) is used internationally to give a numerical grading for the severity of injury that occurs in different body areas. The ISS can be directly correlated with a threat to life and, to a lesser degree, with complications, length of stay, cost and outcome.
Mō te tikanga o te ngaukino nui ka meatia e mātou te tikanga a te Major Trauma Network: “He ngaukino nō ngā tūroro kua pāngia ki tētahi whara ā-tinana nā te whakawhitinga pūngao (pērā i tētahi tukinga waka) kaua nō ngā mate ā-roto (pērā i te tahumaero) me tētahi Ine Whara Kino (IWK) 13 neke atu”. Ko te Ine Whara Kino (ISS) he ine ka mahia huri noa i te ao e homai ai he taumata ā-tau mō te kino o te wharanga ka pā atu ki ngā wāhanga rerekē o te tinana. Ka hāngai pū te IWK ki tētahi turituri ki te oranga, ā, ki ētahi atu tūāhua iti nei pērā i ngā pōauautanga, te roa o te noho, te utu me te otinga.