Bellingen Theatre Initiative
11 April 2016 Last updated:
28 April 2016
The Bellingen Theatre Initiative
Coffs Clinical Network (CCN) introduced new surgical services at Bellingen Health Campus (BHC) and developed a centralised surgical waitlist, referral and admission process across Coffs Harbour, Macksville and Bellingen Health Campuses.
Download a poster from the Centre for Healthcare Redesign graduation, April 2016.
To increase surgical allocation at BHC from 150 to 390 by June 2016 and increase service capacity by commissioning new services at BHC by February 2016.
- Increases patient, carer and staff satisfaction and consumer confidence.
- Enables better access to surgical services by improving surgical allocation rates.
- Reduces day of surgery cancellation rates.
- Increases patient capacity within the hospital.
- Reduces procedure waiting times.
- Delivers a networked approach to surgical services.
- Improves linkages between sites and provides opportunities for improved professional development and service collaboration.
- Improves efficiency of surgical waitlist and referral processes.
The demands on surgical services within the CCN increased significantly between January 2014 and June 2015, resulting in full session capacity at both Coffs Harbour and Macksville Health Campuses. In particular, an increase in emergency surgeries at Coffs Harbour Health Campus was causing high numbers of day of surgery cancellations.
Allocation of procedures across the CCN over a four-year period showed that Coffs Harbour Health Campus was at capacity, with increased activity at Macksville Health Campus and decreased activity at BHC.
These results identified a need for elective surgeries to be conducted at BHC where possible. However, its aging infrastructure meant that BHC did not meet the Australian Health Facility Guidelines or the Australian College of Operating Room Nurses standards for Stage 1 Recovery. At the time, there were no recruited perioperative staff at the facility and limited surgical and anaesthetic support. These factors made it difficult to introduce new services that would ease demand and support capacity at Coffs Harbour and Macksville Health Campuses.
Introducing new services at BHC was deemed critical to meet CCN key performance indicators, including Elective Surgery Access Performance and day of surgery cancellation rates. To address this need, renovations were undertaken to the Stage 2 Recovery (Day Surgery) area at BHC and completed in 2014. Equipment was also purchased with the intention of offering ophthalmological services.
As part of MNCLHD Rural Capital Investment Program in 2014-15, BHC received additional funding for the refurbishment of the Stage 1 Recovery and Operating Suite. This included the provision of new endoscopic facilities. The renovations enabled BHC to provide high-volume short-stay procedures including endoscopic, ophthalmological and low-risk general surgery.
It was anticipated that by commissioning these new services and improving the waitlist allocation of high-volume short-stay elective procedures, BHC would be able to improve patient access to surgical services.
- Centralised waitlist referrals for Macksville and Bellingen Health Campuses.
- Centralised preadmissions triage and phone clinics for Macksville and Bellingen Health Campuses.
- Realigned current management model to create a centralised governance structure. This comprises a new nurse manager position and a regrade of patient service coordinator to patient service manager, as follows:
- the nurse manager will implement clinical governance and coordinate perioperative services, with the support of perioperative nurse unit managers at each site
- the patient service manager will provide governance, waitlist management, CCN coordination and allocation for Bellingen and Macksville Health Campuses, with the support of perioperative nurse unit managers at each site. Responsibilities include outpatient services for pre-admission clinics, haematology and HIV clinics, antenatal and allied health clinics.
- Combined three surgical services as one networked surgical service, called ‘Coffs Coast Surgical Services’ (in progress). Developing this service will involve consultation with various committees and forums. Consumer awareness will be raised through promotional videos, brochures, videos played on inpatient televisions and in emergency department waiting rooms. Brochures will also be distributed to CCN facilities, community transport providers and local primary and community health services.
- Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.
- Project start: March 2015
- Project finish: June 2016
- Evaluation: March 2017
- Macksville Health Campus, MNCLHD
- Bellingen Health Campus, MNCLHD
- Centre for Healthcare Redesign
Evaluation and results
- A full evaluation is planned to commence in March 2017 and will include the following key performance indicators and measures:
- elective surgery access performance
- day of surgery cancellation rates
- session capacity at Coffs Harbour, Macksville and Bellingen Health Campuses
- surgical allocation levels at BHC
- number of waitlist referrals
- statistics from preadmissions triage and phone clinics
- occasions of service for newly-commissioned services at BHC
- patient and staff satisfaction.
- Surveys of 195 patients between December 2015 and February 2016 showed that 99.8% found the care and delivery of new services to be excellent.
- Staff satisfaction continues to grow as service ownership develops. Permanent recruitment to the new perioperative positions has been completed, with all positions filled by new and existing employees. Three new employees have commenced postgraduate studies in perioperative nursing.
- Strong leadership, clinician engagement and resource management were critical to the project’s success.
- We found the project needed dedicated resources and support long after it was implemented.
- Roadblocks and barriers can occur at any time, regardless of planning.
- The project required a broad level of stakeholder engagement and sponsor support.
- NSW Ministry of Health. Rural Surgery Futures 2011-2021. North Sydney: NSW Health; 2012.
- NSW Ministry of Health. NSW Rural Health Plan: Towards 2021. North Sydney: NSW Health System Planning and Investment; 2014.
- Agency for Clinical Innovation. Operating Theatre Efficiency Guidelines. Chatswood: ACI Surgical Services Taskforce; 2015.
- NSW Ministry of Health. High Volume Short Stay Surgical Model Toolkit: Guideline GL2012_001; 2012.
- Australian College of Operating Room Nurses. ACORN standards for perioperative nursing 2014-2015. Adelaide: ACORN ; 2014.
- Gastroenterological Society of Australia. Infection Control in Endoscopy: Clinical Update (3rd Ed. 2010). Victoria: Digestive Health Foundation; 2011.
- Gastroenterological Society of Australia. Endoscopy: Standards for Endoscopic Facilities and Services (3rd Ed. 2006). Victoria: Digestive Health Foundation; 2011.
Perioperative Nursing Unit Manager
Macksville Health Campus
Mid North Coast Local Health District
Phone: 02 6568 0632
Deputy Director of Nursing
Bellingen Health Campus
Mid North Coast Local Health District
Phone: 02 6659 5805
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