[HSF] Death on waiting list

Mon Apr 16 23:41:00 EDT 2007

In South Africa the waiting list in the state
hospitals are anything from 4 to 10 months, depending
on the region...very, very frustrating, and I estimate
the mortality is not more than 10%, from the records
we kept. It is interesting that the patients already
have waited 6 months to a year before getting to the
cardiology clinic. Patients with mainstems, severe
coronary disease with ischaemic cardiomyopathy, AS
with gradients in the 100`s are more often than not
still around after a year. They will usually then
present as emergencies, and then get priority, so
usually not die.

In the private sector, where I now do most of my work,
the wait depends on the surgeon. We are pushed to do
healthy elective patients on the same day by the
cardiologists,but always wait at least until the next
day, unless its really urgent. We generally try to
rather get them home for a few days. It is good to let
the contrast clear out, and our feeling is that you
may get less of a surgical inflammatory response by
waiting. Just track the creatinine and CRP for 3 days.
We all know about the creat, but watch the CRP go over
150 in some cases. Also, there is often an enzyme leak
post angio, usually because the cardiologist has been
trying to wedge in a stent, and this may end up with a
resus! All without your knowledge. You should hang
around the cath lab a bit, and see how unstable the
cardiologists can make them. So we wait a bit, from
what we have seen, a few days does more good than
harm.

We often comment on how much easier the patients are
in private practice, and in the state hospital a
`routine` case is often referred to as a `private
patient`.

The long waiting lists are horrific, as patients are
often cancelled a few times due to more emergent cases
jumping the list. The system is a reflection of the
state spending less money on health, trying to
maintain control on health systems, and simply the
usual consequence of a state run, inefficient
department.

Dave Harris

--- Ben Bidstrup <benjamin.bidstrup at bigpond.com>
wrote:

> But does that give the team time to fully assess the
> patient?
> 
> >In Israel the waiting time is about the time it
> takes our Blood Bank 
> >to prepare 2 units of cross-matched packed cells...
> >
> >Jay Lavee
> >
> >----- Original Message ----- From: "Salerno, Tomas"
> <TSalerno at med.miami.edu>
> >To: <OpenHeart-L at lists.hsforum.com>;
> <OpenHeart-L at lists.hsforum.com>
> >Sent: Monday, April 16, 2007 7:35 AM
> >Subject: RE: [HSF] Death on waiting list
> >
> >>waiting lists in the USA are in general about one
> hour
> >>
> >>TS
> >>
> >>________________________________
> >>
> >>From: openheart-l-bounces at lists.hsforum.com on
> behalf of Tea Acuff
> >>Sent: Mon 4/16/2007 12:32 AM
> >>To: OpenHeart-L at lists.hsforum.com
> >>Subject: Re: [HSF] Death on waiting list
> >>
> >>
> >>
> >>About the only waiting going on in the United
> States of America (no 
> >>ugly "American" short hand) is over the weekend.
> Excepting the 
> >>Veterans Administration Hospitals of course.
> >>tea edward acuff junior medical doctor
> >>
> >>
> >>----- Original Message ----
> >>From: Tina i Mladen Kocica <kocica at sezampro.yu>
> >>To: OpenHeart-L at lists.hsforum.com
> >>Sent: Sunday, April 15, 2007 9:59:59 PM
> >>Subject: [HSF] Death on waiting list
> >>
> >>
> >>Our heart surgery waiting lists (WL), here in
> Serbia, are permanently
> >>growing, with today average of about 1000 people
> per centre annualy. It
> >>seems that we do not make them properly, since
> death rate on WL is also
> >>permanetly increasing (from 8% three years ago to
> 15% last year).
> >>Questions:
> >>1) General opinion about WL for heart surgery
> (ethics)?
> >>2) Criteria? Who makes them?
> >>3) Your annual WL load?
> >>4) Your WL mortality?
> >>
> >>Regards,
> >>Mladen
> >>
> >>Mladen J. Kocica, M.D.
> >>
> >>Clinic for Cardiac Surgery
> >>
> >>Institute for Cardiovascular Diseases
> >>
> >>UC Clinical Centre of Serbia
> >>
> >>8th Kosta Todorovic St.
> >>
> >>11000 Belgrade
> >>
> >>Serbia
> >>
> >>Tel: + 381 (11) 3670609
> >>
> >>Fax: + 381 (11) 3610880
> >>
> >>E-mail:  <mailto:kocica at sezampro.yu>
> kocica at sezampro.yu
> >>
> >>URL:  <http://www.kocica.org/> www.kocica.org
> >>
> >>URL:  <http://www.ctsnet.org/home/mkocica>
> www.ctsnet.org/home/mkocica
> >>
> >>URL:  <http://www.srscvs.org/> www.srscvs.org
> >>
> >>
> >>
> >>
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> 
> -- 
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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=== message truncated ===

Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411             
Fax +27-21-9006412      Mobile +27-83-3309587