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Emergency Surgery: Why The Wait?

Project Added:
30 November 2016
Last updated:
16 December 2016

Emergency Surgery: Why The Wait?

Summary

The Tweed Hospital implemented a number of solutions to streamline and improve the surgical journey of emergency surgery patients. These included education for staff and patients, development of new care pathways and implementation of electronic booking and referral systems.

View a poster from the Centre for Healthcare Redesign graduation, December 2016.

Aim

To ensure 95% of patients who require surgery within 24 or 72 hours are sent to the operating theatre within their allocated surgical category, by January 2017.

Benefits

  • Reduces delays to theatre for emergency surgery patients, without compromising safety.
  • Reduces preoperative and post-operative length of stay.
  • Improves patient and staff satisfaction.
  • Increases understanding of surgical categories and care pathways.
  • Reduces adverse outcomes for emergency surgery patients.
  • Improves overall patient flow in the hospital.
  • Maximises activity-based funding and reduces healthcare costs.
  • Improves national elective surgery targets.
  • Reduces unnecessarily long preoperative fasting.

Background

Anecdotal feedback from staff at The Tweed Hospital in 2016 highlighted increasing delays for general surgical patients who required emergency surgery. In some cases, delays were caused by staff not allocating patients to the correct emergency surgery category according to their clinical need. These delays led to bed block, extended preoperative and post-operative length of stay, poor patient experience and dissatisfaction of the service. As a result, there was an increased risk of adverse outcomes.

Surveys with patients and staff conducted in April 2016 found there was a misconception that when a patient is booked for emergency surgery, they will have surgery on that day. They were unaware that there are six emergency surgery categories. For patients, this lack of knowledge led to increased anxiety and frustration. Lack of knowledge for staff meant that patients were not always booked according to clinical need and at times, incorrect information was provided to patients and carers.

The surveys also showed that in some cases, patients would be sent to theatre without being fully prepared preoperatively, which meant the surgery was postponed until the patient could be adequately assessed. The existing process for booking, preparing patients for surgery and communicating with staff, theatres and patients was unclear.  Anaesthetists reported that at times, patients were not medically fit when they arrived at the operating theatre.

Prior to the project, a paper system for booking patients for emergency surgery was used. This lacked transparency, led to delays in surgery and increased the risk of transcribing errors.

Implementation

  • Face to face education workshops were provided to nurses, registrars and visiting medical officers, to increase awareness of emergency surgery categories.
  • Brochures were developed to educate emergency patients requiring surgery and their carers about the admission process, surgical categories, possible delays and who to speak to for further information. These brochures were provided to patients on admission to the hospital.
  • Posters were produced and displayed in the ward areas of the hospital, to educate staff and general public on emergency surgery categories.
  • A new care pathway was developed, which outlined the process for patients requiring emergency surgery, ensuring a smooth transition from admission to surgery.
  • A new care pathway was developed to ensure all patients awaiting emergency surgery are fit to receive an anaesthetic. This aimed to reduce unnecessary delays in surgery, due to a lack of medical information or test results.
  • Recommended pathology tests were included in the new care pathways, to avoid any unnecessary delays to surgery due to a lack of screening.
  • An electronic white board was installed with a ‘read only’ screen, which provided ward staff with easy access to SurgiNet and up-to-date theatre schedule information. This enabled staff to track patients who were awaiting surgery or in surgery.
  • An electronic referral system for booking emergency surgery cases was implemented. This provided accurate surgical booking times, as well as the ability to view cases in real time and generate accurate reports from the data generated.

categories and definitions used in emergency surgery prioritisation

Project status

Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

February 2016 – January 2017

Implementation site

The Tweed Hospital, Northern NSW Local Health District

Partnership

Centre for Healthcare Redesign

Evaluation

  • A full evaluation will be conducted in January 2017.
  • Patient and staff surveys were conducted pre-implementation (April 2016) and post-implementation (October 2016). Results demonstrated an improved understanding of emergency surgery processes.
  • A review of the patient journey was conducted in April 2016, measuring the patient’s experience of the service and their perception of delays to theatre. These baseline results will be used to compare improvements in the final evaluation.
  • Monthly audits of patients that required surgery within 24 or 72 hours were undertaken from March 2016. Data was collected using electronic medical records that measured emergency theatre wait times specific to this patient cohort. Results to date are as follows:
  • 83% of patients who required surgery within 24 hours met the key performance indicator benchmark of 85% in September 2016, up from 74% in March 2016
  • 93% of patients who required surgery within 72 hours met the key performance indicator benchmark of 95% in September 2016, up from 85% in March 2016.

Lessons learnt

Throughout the project, providing education and progress updates has been key to engagement.  

Related reading

Contacts

Fran Hofstee
Nurse Unit Manager, Surgical Ward
The Tweed Hospital
Northern NSW Local Health District
Phone: 07 5506 7450
fran.hofstee@ncahs.health.nsw.gov.au

Shirley Walker
Whole of Health Project Officer
The Tweed Hospital
Northern NSW Local Health District
Phone: 0437 721 230
shirley.walker@ncahs.health.nsw.gov.au

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