Welcome to the Surgery Newsletter.
The Ministry of Health supports Local Health Districts and Health Networks to develop and implement local improvement strategies, monitors performance against key indicators and shares knowledge regarding elective surgical services.
There is great work happening across NSW to improve on-time access to elective surgery.
Hello everyone
Welcome to the first edition of Surgery News for 2016. For the period January to March 2016, the Bureau of Health Information reports that 97% of elective surgery in NSW was performed on time. This result is a real credit to the staff in our busy hospitals who are working towards ensuring all our patients have timely access to appropriate surgical services. As you are also aware, surgical performance is a state priority and the Government has committed significant additional resources to support the efficient management of surgery waiting lists.
So far 2016 has been an extremely busy year for the Surgery Teams in the Ministry of Health and in the Local Health Districts and Specialty Health Networks.
The Ministry of Health Surgery Team are currently working with the Agency for Clinical Innovation at the Surgery Redesign School, reviewing the draft Waiting Time and Elective Surgery Policy, assisting sites with performance and working closely with the EDWARD/OPERA Team.
I look forward to hearing more about the great work that is being done in the surgical arena at both District/Network and facility level in the future.
RegardsSusan Pearce
The Ministry of Health Surgery Team are in the System Purchasing Branch. From left to right in the photo are:
Melinda joined the Surgery Team in January 2016. Prior to this, she spent the previous 3 years providing state wide support for the implementation and development of the Patient Flow Portal and Patient Flow Systems Framework. Melinda has held several senior Nursing position within South Eastern Sydney Local Health District including extensive experience in the perioperative environment.
Phone: (02) 9391 9557Email: mpasc@doh.health.nsw.gov.au
Elizabeth joined the Ministry as the Associate Director, Purchasing and Performance within the System Relationships and Frameworks Branch in 2013, and has been instrumental in driving the improvement of the Service Agreement development and negotiation processes, both internally within the Ministry, and externally through enhanced collaboration with the Districts and Networks.
Phone: (02) 9391 9880Email: ewood@doh.health.nsw.gov.au
Annette joined the Ministry in 2009 as one of the Clinical Redesign Program team and has led statewide projects in Advance Care Planning and Hospital in the Home. Since 2012 she has been part of the now named System Purchasing and System Management Branches that develop annual Service Agreements as well as supporting Districts and Networks in the management and improvement of health system performance.
Phone (02) 9391 9932Email: amarl@doh.health.nsw.gov.au
Access to Operating Theatres, facilitating the management of both elective and emergency surgical cases is a significant factor that can impact on patient flow in many organisations.
At Bankstown Hospital, in the past four years, Nurse Manager Eleanor Halvey has implemented a significant number of strategies to improve patient flow and to promote timely patient care as the focus within Perioperative Services from an elective and emergency case management perspective. Highly skilled and empowered nursing clinicians support safe patient care on a daily basis. Nursing practice is standardised through the use of evidence based competency packages which encompass relevant standards, policies and guidelines.
One of the major challenges was to review demand and access to the Operating Theatres and based on this to then reintroduce a 24 hour staffing model into the Perioperative Suite replacing the On Call Night Duty model that had previously existed. This process initially involved reviewing the demand and activity including number of cases completed and considering the call backs costs, sick leave and staffing issues, emergency surgery postponements and reviewing weekend activity.
The new model required significant recruitment and involved reconfiguring nursing rosters and addressing staff issues. A decision was made to introduce the Night Duty roster on a rotating basis that would be covered by all suitably trained staff. This rotation would also assist staff to maintain their continuing professional development and participate in staff meetings.
In addition to the existing Emergency Theatre that is staffed 24 hours 7 days a week. The following sessions have been introduced:
These meetings are held daily at 8.15, 13.30 and 15.30. They are attended by the Perioperative Nurse Manager and the Operating Suite Nurse Unit Mangers or In Charge of shift. They provide the opportunity to review the current status of the Perioperative Service, any current or expected issues including mitigation strategies where appropriate.
This meeting reviews upcoming theatre sessions. The focus is to improve care of the surgical patients and decrease cancellations.
Attendees:
During the meeting when reviewing the session bookings, a list of each surgeon’s average time taken per procedure is used as a reference guide. A report is then sent to the Director of Anaesthetics, the Director of Surgery and the Patient Flow Manger detailing the predicted patients for the next week.
This meeting is to review and track wait list management in relation to Category A, B, C and D patients for the current month plus projecting three month in advance to assist with meeting key performance indicators on an ongoing basis.
This meeting assists with additional elective session allocation to individual surgeons to assist with ongoing wait list management. Elective and emergency activity is reviewed in relation to patient flow and bed demand across the hospital.
This meeting involves a review of the data in Activity Folder. The reports reviewed are:
All of the strategies detailed above are intended to promote safe and timely access to the Perioperative Service. This is evaluated by regular review of performance data to assess past performance and to identify future projects.
For further information please contact:
Eleanor HalveyNurse Manager Perioperative ServicesBankstown-Lidcombe HospitalPhone: (02) 9722 8435 Switchboard: (02) 9722 8000 Pager: 28094Fax: (02) 9722 8455 Email: Eleanor.Halvey@sswahs.nsw.gov.au
A number of hospitals have partnered with the Agency for Clinical Innovation (ACI) to implement the Operating Theatre Efficiency Guidelines.
The Operating Theatre Efficiency Guidelines are comprised of three main sections.
Successful implementation of the Operating Theatre Efficiency Guidelines requires a collaborative multidisciplinary OT team approach.
To further assist sites to identify opportunities for improvement the ACI has developed an Operating Theatre Self-Assessment. The tool is aligned to the efficiency guidelines and allows managers and clinicians to quickly identify areas to focus on for further investigation through the use of drop down questions and a dashboard.
The tool will be available for download by the end of March and the ACI team is available to assist sites to undertake an assessment.
Gavin Meredith - Manager, Surgical ServicesPhone: (02) 9464 4644 Email: gavin.meredith@health.nsw.gov.au
Ellen Rawstron - Manager, Anaesthesia and Perioperative Care NetworkPhone: (02) 9464 4641 Email: ellen.rawstron@health.nsw.gov.au
Sarah-Jane Waller - Ophthalmology Network ManagerPhone: (02) 9464 4645 Email: sarahjane.waller@health.nsw.gov.au
Leanne Creighton - SACC Project OfficerPhone: (02) 9464 4661 Email: leanne.creighton@health.nsw.gov.au
EDWARD is NSW Health’s Strategic Clinical Data Warehouse that will replace all Health Information Exchanges (HIEs). The Wait List deployment has extended to the 10 iPM Local Health Districts (LHD), with some LHDs reaching the final stages, preparing their internal training activities.
Cerner Wait List LHDs continue to have a dependency on the Cerner Waiting List Module Optimisation Project. For more information on this project, please contact the project Secretariat, John Hallett of Health System Information and Performance Reporting Branch.
We have released the Forward Planning reports (beta version) as part of the draft WL Policy reports in OPERA. These reports deliver Patients on List information to aid LHDs in managing the Wait List on the following basis:
For more information on the programs there is online information as well as local and program contact information.
Program Director - Robert CoppolinoPhone: (02) 8918 1601Mobile: 0402 881 668Email: robert.coppolino@health.nsw.gov.au
Solutions Architect - James PriorPhone: (02) 8918 1606Mobile: 0448 789 939Email: james.prior@health.nsw.gov.au
Senior Business Analyst / Training Lead - Jillian AshbyMobile: 0458 573 912Email: jillian.ashby@health.nsw.gov.au
Change Manager - Kate HolzPhone: (02) 8918 1608Mobile: 0412 360 860Email: kate.holz@health.nsw.gov.au
Central Coast Local Health District provide an overview of a project which implemented a number of pre-warming strategies, to reduce the incidence of inadvertent hypothermia in surgical patients.
To increase the rate of patients who achieve a normothermic state prior to induction of anaesthesia by 10% within three months.
A patient survey undertaken in August 2014 showed that many patients felt cold in the surgical admissions area of Gosford Hospital. Although waiting room temperatures were increased as a result of the feedback, it was determined that further investigations needed to take place, to determine where patients were likely to become cold and how it affected their health outcomes and experience.
It is vitally important that patients having surgery are at an optimal temperature (known as a normothermic state) prior to undergoing an anaesthetic. If the patient has a temperature of less than 36 degrees Celsius, they are at increased risk of a number of complications, including haemorrhage, myocardial ischaemia and post-operative infections. They may also experience lengthy wound healing and recovery time. Managing just one of these post-operative infections can be devastating to the patient and cost the healthcare system around $10,000 per patient.
A retrospective audit conducted in January 2015 showed that 52% of patients arrived in the recovery unit of hospitals in Central Coast Local Health District with inadvertent hypothermia. A solution was required to reduce the incidence of inadvertent hypothermia and make the patient more comfortable during their hospital stay.
Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.
January 2015 to February 2016
Tracy KerleNurse Manager, Perioperative Services, Gosford HospitalCentral Coast Local Health District Phone: 4320 3471Email: tracy.kerle@health.nsw.gov.au
Staff from Wagga Wagga Health Service recently visited their colleagues at Bankstown Hospital. The purpose of the visit was to discuss booking office processes including staffing and structure, work volumes and provided an opportunity for information sharing.
From left to right in the photo are: Catherine Parsons, Waitlist Manager Bankstown Hospital; Gabi McCormack, Booking Officer, Wagga Wagga Health Service; Suellen Gaynor, Surgical Patient Flow Manager, Wagga Wagga Health Service and Jane Chan, Waitlist Supervisor, Bankstown Hospital
