Wollongong Hospital developed electronic scheduling systems, patient education materials and a clinical review process, to reduce wait times in its Endoscopy Unit.
View a poster from the Centre for Healthcare Redesign graduation, May 2018.
Aim
- To increase clinical review of request for admission (RFA) forms from 26 per cent 100 per cent by December 2017.
- To reduce wait times for an endoscopy clinic appointment from six months to three months by January 2018.
- To improve communication of appointments, procedures and processes to 100 per cent of endoscopy patients by March 2018.
Benefits
- Reduces wait times for people who require an endoscopy procedure.
- Increases access to specialist consultations to meet patient demand.
- Reduces unplanned cancellations of clinic appointments and procedures.
- Improves the efficiency of endoscopy lists and clinician time.
- Improves patient communication, experience and health care journey.
- Provides a coordinated and client-centred approach to service delivery.
- Improves compliance with National Bowel Screening Guidelines and equitable access to endoscopy services.1
- Reduces healthcare costs associated with delivering endoscopy services.
Background
Colorectal (bowel) cancer is one of the most commonly diagnosed cancers in Australia and the second most common cause of death from cancer in Australia. Evidence shows that if bowel cancer is diagnosed early with an endoscopy, it has a 90 per cent survival rate. However, data shows that only 40 per cent of Australians are diagnosed at this early stage, resulting in a 66 per cent survival rate.2
In March 2016, an external review of the Endoscopy Unit at Wollongong Hospital was undertaken, following anecdotal feedback from staff about the significant increase in the number of patients on the wait list and the length of time they were required to wait for a specialist consultation.
At the time, there were 778 patients on the wait list and the wait time for a consultation was between six weeks and six months. In addition, wait time for each category was over the recommended time frame1: Category A was 56 days (target 30 days); Category B was 210 days (target 90 days); and Category C was 425 days (target 365 days).
The delays to consultation, diagnosis and treatment caused by the extended wait list at Wollongong Hospital had the potential to not only impact the survival rate of patients, but also their health care experience. Following the external review, a number of key issues were identified.
- The endoscopy clinic could not provide enough appointments to meet the demand for specialist consultations, partly due to an outdated scheduling system.
- Many patients were not showing up to their appointments, resulting in an inefficient use of limited resources.
- There was no formal process for reviewing the RFA form, which resulted in cancellations on the day of procedure.
- Only 67 per cent of RFA forms were filled in correctly, with many getting lost, not arriving at the Admissions Department and not dated in a timely manner.
- There was inadequate communication to patients, with surveys revealing that many patients felt they did not have enough information to prepare for their procedure.
- Written information provided to patients was outdated and verbal instructions often varied between departments.
- The endoscopy procedure list was underutilised, due to time scheduled for emergency cases, outdated scheduling processes and unplanned cancellations.
Implementation
- Patient information about the preparation required and what to expect on the day of the procedure was revised and standardised. This information is now available on the patient information portal and can be distributed across the local health district.
- A process was developed in consultation with the Admissions Department about providing information to patients. The relevant information is now sent with the letter, notifying the patient of their procedure date.
- A business rule was developed to send Category B patients to Shellharbour Hospital for endoscopy procedures. This was implemented to help reduce the Wollongong wait list for endoscopy procedures.
- Electronic scheduling is being implemented, with patients booked into allocated timeslots by the Admissions Department. This process is based on the NSW Health Guideline The Perioperative Toolkit.3
- A business rule was developed to identify patients who are suitable to attend at short notice to cover unplanned cancellations.
- Documenting the patient’s journey through the department using SurgiNet will be implemented in June 2018, to complement electronic scheduling.
- A new process will be implemented, where a nurse will contact patients one week prior to admission to review their RFA form, assess their readiness for the procedure and provide education materials.
- Other solutions, such as an electronic wait list system and electronic general practitioner referrals are currently in development.
Status
Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.
Dates
April 2017 - July 2018
Implementation sites
Endoscopy Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District
Partnerships
- Centre for Healthcare Redesign
- South Eastern NSW Primary Health Network
Evaluation
Due to delays with implementing some solutions, a full evaluation will not be possible until July 2018. To determine whether the project objectives have been achieved, the evaluation will include:
- an audit of electronic medical records to measure the percentage of time the procedure room is unused (such as cancellations)
- an audit of clinic data for the consulting rooms to measure wait times and unplanned cancellations
- an audit of RFA forms screened by a nurse prior to the procedure
- patient surveys to measure the effectiveness of patient communication and education materials, as well as satisfaction with the service
- a staff survey to measure satisfaction with the new processes.
Lessons learnt
- Sponsorship support and management buy-in is crucial to the success of the project.
- Competing projects are a major risk to the timely progression of any project.
- Key stakeholders need to be involved at every stage to achieve the desired outcomes.
References
- NSW Ministry of Health. Waiting Time and Elective Surgery Policy. North Sydney, NSW: NSW Health; 2012.
- Australian Government. Bowel cancer (colorectal cancer) in Australia. Sydney, NSW: Cancer Australia; 2018.
- NSW Ministry of Health. The Perioperative Toolkit GL2018_004. North Sydney, NSW: NSW Health; 2018.
Further reading
- Bowel Cancer, Cancer Council Australia
- Colorectal Cancer in Australia, Australian Institute of Health and Welfare
Contacts
Michaela Baginski
Clinical Redesign Lead
Illawarra Shoalhaven Local Health District
michaela.baginski@health.nsw.gov.au
Kerry Arnold
Clinical Nurse Educator
Illawarra Shoalhaven Local Health District
kerry.arnold@health.nsw.gov.au
