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RESCUERS: Reduce elective surgery cancellations utilising existing and realigning services

Manly HospitalMona Vale HospitalHornsby Ku-ring-gai Hospital
Project Added:
4 December 2014
Last updated:
8 December 2014

RESCUERS: Reduce elective surgery cancellations utilising existing and realigning services

Summary

An elective surgical project was conducted across the three hospital sites of Manly, Mona Vale and Hornsby. The aims of the project were to reduce the number of “no bed” cancellation of elective surgery to improve access to surgery. To increase the types of procedures that can be performed as Day Only procedures and improve access to surgery.

Download a poster about this project from the Centre for Healthcare Redesign graduation, December 2014.  

Aim

Equitable, timely access to a surgical journey of co-ordinated care and informed preparation, for all stages, resulting in best patient outcomes and the most efficient use of resources.

  1. Reduce the number of elective surgical cancellations due to no post-operative bed by 50% on each site by 31 December 2014. 
  2. To increase the percentage of surgical patients treated as day only admissions to 80% of all elective surgical patients by 30 June 2015.

Benefits

  • Improved timely and equitable access to elective surgical services
  • Improved patient experience and outcomes
  • Improved planning of theatre lists and hospital bed management
  • Improved performance

Background

An increasing number of elective surgical patients were being cancelled due to the non-availability of post-operative surgical beds. This led to increased patient dissatisfaction and poorer theatre utilisation with increased difficulty in meeting National Elective Surgery Targets (NEST). “No bed” cancellations were running at 32% of all elective surgery cancellations.

There was a discrepancy of the types of procedures being performed as day only when the three sites were compared. All three sites were not meeting the NSW Ministry of Health day surgery target of 80% - an average of the three sites showed a performance of 53% in 2013.

Total elective surgery beds and medical beds March-April 2014

 

Graph of no bed cancellations 2012-13 

Implementation 

  • Weekly “theatre bookings” meeting with theatre manager, wait list coordinator, nurse screener and patient flow coordinator at each hospital to review all elective surgery bookings for four weeks prior to surgery date.
  • Weekly “theatre bookings” meeting held with elective surgical admissions limited to set daily limits.
  • Bed classifications are checked and changed to ‘Day Only’ if suitable and with consultation with the requesting surgeon.
  • List length is checked and the surgeon is advised if lists are over or under booked.
  • Patients are placed on standby rather than cancelled.
  • Standardisation of the Referral for Admission information required to ensure it is provided.
  • Request for Admission (RFA) minimum data set education completed and incomplete RFA's are returned for correction before the patient is entered onto the hospital wait list.
  • Scheduling of theatre lists to improve patient throughput. Consultation with other Local Health Districts to gain further ideas on suitable day only procedures and how they are managed.
  • Criteria led discharge for day surgery patients to minimise discharge delays. Criteria led discharge parameters have been introduced to the day surgery ward.
  • Clinical pathways developed to ensure consistent case management practices. Clinical pathways for total hip and knee procedures and for thyroid surgery are in development. A consistent pathway will then be introduced for all three sites.
  • Theatre template review to better distribute elective surgical overnight bed needs. Each site has identified their individual template change needs to even out the elective surgery beds demand. These changes are continuing.
  • Quarantine surgical beds for elective surgical patients.

Results

The weekly "theatre bookings" meeting has resulted in improved usage of available beds and less "no bed" cancellations.

"No bed" cancellations have decreased from 65 in 2013 to 36 in 2014 as at October 31st 2014.

Graph of percentage of elective surgery patients as day only, showing all hospitals at over 70% between July and August 2014

 

There has been an increase in the types of procedures that can be treated as day only patients. Many minimally invasive parathyroid, anterior cruciate ligament repairs, adenotonsillectomy, laparoscopic cholecystectomy and hernia repairs have all moved to day only procedures with the aid of multidisciplinary working parties or surgeon initiatives.

Site Mandatory data % Complete Waitlist within 3 days receipt date % Complete
Manly 34/34 100% 34/34 100%
Mona Vale 40/40 100% 39/40 97.5%
Hornsby 50/50 100% 49/50 98%

Partnership

The project was undertaken via the Agency for Clinical Innovation’s Centre for Healthcare Redesign program. 

Lessons Learnt 

  • Communication with impacted stakeholders is vital.
  • Our data capture is not comprehensive - necessitating the manual identification and collection of some data.
  • The management of the waitlist and the data quality of the RFA's were unexpected findings during the diagnostics phase of the project.
  • Consultation with other Local Health Districts to gain further ideas on suitable day only procedures and how they are managed.

References

  • Surginet data extracts
  • HIE data extracts
  • electronic medical record (eMR) data extracts.

Contacts

Bronwyn Friend
Nurse Manager
Operating Suite
Mona Vale Hospital
Northern Sydney Local Health District 
Phone: 02 9998 0213
Bronwyn.friend@health.nsw.gov.au

Heather Liddle
Nurse Unit Manager
Operating Suite
Manly Hospital
Northern Sydney Local Health District
Phone: 02 9976 9751
Heather.Liddle@health.nsw.gov.au

Mary Rose
Nurse Manager
Operating Suite
Hornsby Hospital
Northern Sydney Local Health District
Phone: 02 9477 9135
Mary.Rose@health.nsw.gov.au

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