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.
In this edition
Message from the Executive Director, System Purchasing Branch
Hi everyone, the last few months have been an extremely busy period for NSW Health. Despite increases in volume and the challenges of winter, the percentage of patients who have their surgery completed within their clinically recommended timeframe is at or above target for all three categories.
The August Elective Surgery Access Performance (ESAP) Year to Date results are:
- Category 1: 100% (Target 100%)
- Category 2: 98.4% (Target 97%)
- Category 3: 97.1% (Target 97%)
The most recent Bureau of Health Information Quarterly Report (April to June 2017) highlights included:
- 97 per cent of all elective surgery patients underwent their surgical procedure within the clinically recommended timeframe. This is unchanged compared with the same quarter last year.
- Median wait times were unchanged or slightly shorter than the same quarter last year – 11 and 44 days for urgent and semi-urgent surgery respectively. Non-urgent surgery decreased by 7 days to 225 days compared to 232 days in the same quarter last year.
- There were 57, 881 elective surgery procedures performed, a decrease of 1.1 per cent compared to the same quarter last year.
High volume elective surgery median wait times (compared with the same quarter last year) for:
- Cataract extraction – reduced by 28 days to 221 days
- Cystoscopy – reduced by 2 days to 32 days
- Hysteroscopy – unchanged at 33 days
- Total knee replacement - reduced by 1 day to 285 days
Note: These median wait times are all within the clinically recommended timeframes.
These improvements are an outstanding achievement and a credit to the ongoing hard work and dedication of the many staff in the districts and networks. The ongoing efforts are well recognised by the Ministry.
Congratulations! Working hard together as a team with one vision truly wins in the end. Excellent work guys! Your hard work has truly paid off.
Executive Director, System Purchasing
Increasing access to Elective Surgery Initiative 2017 - NSW Heath Funding Boost for Elective Surgery Performance
Improving Elective Surgery Access through Partnerships
In 2017/18 the NSW Ministry of Health will provide an additional $3 million dollars to further improve access to elective surgery services in NSW. Through a formal Expression of Interest process, funding will be provided to districts and networks to undertake additional elective surgeries.
The initiative was open to all districts and networks with median waiting times greater than the NSW state average as detailed in the Bureau of Health Information (BHI) Healthcare Quarterly, January to March 2017:
- Cataract extraction (Category 3, median wait time 230 days)
- Total knee replacement (Category 3, median wait time 291 days)
- Total hip replacement (Category 3, median wait time 223 days)
The extra surgeries must be completed in addition to the agreed ‘Admissions off the Elective Surgery Waiting List’ target within the 2017/18 Service Agreement.
A Request for Proposal (RFP) was emailed to all districts and networks and we had a strong response from across the state including from rural and regional NSW.
Responses have been reviewed by an Evaluation Panel comprising representatives from the Ministry of Health and the Agency for Clinical Innovation.
The Evaluation Panel will endorse a recommendation that will be advised by the Deputy Secretary, System Purchasing and Performance Division. Successful districts and networks can expect to be notified shortly.
NSW has the best on-time elective surgery performance in the country. During 2016/17 NSW maintained or improved on-time performance in all clinical priority categories, sustained or reduced median wait times across all categories, and delivered in excess of 5,000 additional elective surgeries.
The volume of overdue patients remained low throughout 2016/17, with 210 patients overdue at the end of June 2017. Considering the additional patient presentations experienced across NSW, the ability for the system to deliver these performance results for elective surgery is exceptional.
ACI Multidisciplinary Stakeholder Forum - Integrated Surgical Care for Older People
This unique forum aims to identify opportunities for NSW hospitals to improve the outcomes for older people following surgery. Mapping how perioperative care is being managed for older people in NSW is crucial given the range of co-morbid conditions that may influence their perioperative care. This important area of health care needs your input!
The exciting day will be interactive, giving attendees the opportunity to share examples, generate discussion on how to address common challenges, as well as identifying priorities and impetus for local and state-wide improvement.
Join us at the forum and let’s discuss together:
- data available to identify opportunities to improve outcomes following surgery.ata available to identify opportunities to improve outcomes following surgery
- use of existing toolkits to support & encourage integrated/multidisciplinary care.se of existing toolkits to support & encourage integrated/multidisciplinary care
- challenges and barriers to integrated/multidisciplinary care across the perioperative pathway
- examples of integrated surgical care for older people, currently in use or planned, including cost-effective solutions to overcome the challenges and barriersxamples of integrated surgical care for older people, currently in use or planned, including cost-effective solutions to overcome the challenges and barriers
- come and be part of this new and proactive informative Forum.ome and be part of this new and proactive informative Forum.
Who should attend?
The forum will be of use to anyone with an interest in improving perioperative care and services for older people, including:
- Surgeons, anaesthetists, geriatricians, ICU staff, surgical and pre-admission nursing staffs, Allied Health Practitioners (particularly physiotherapists and dieticians), Health Managers & Discharge Planners.
- Those who have an interest in improving outcomes of perioperative care and services for older people
Please note: No travel is provided by ACI for this Forum. Please seek travel support from your applicable LHD. This is a full day event from 9.30 am to 4.00 pm with a buffet lunch provided.
Registration closes on Monday 6 November at 5pm. Maximum capacity is 100 people. You can get more information and register at the ACI website.
Spotlight: Meet Leonie Sens, Patient Services Manager, Coffs Harbour Base Hospital
Tell us about your career trajectory?
I started working at Royal Prince Alfred Hospital 39 years ago in 1978 when I was 20 years old (guess how old I am now?) in the Medical Record Department. Due to my ‘raucous laugh’, the boss moved me upstairs to the Bed Allocation/Booking Office.
This is where my passion for waiting list management developed and I was soon promoted to Supervisor of this Department. I then progressed to the Manager, Patient Registration (Admissions, Bed Allocations, Outpatients, Emergency Department and Switchboard clerical staff).
In 1994 I was appointed as the Central Sydney Area Health Service’s Waiting List Coordinator and spent a brief secondment with the Performance Branch at NSW Health developing the first Waiting List Policy.
In 1994, after the birth of my second child I moved to Coffs Harbour to be nearby my ageing father. I was approached by Coffs Harbour Hospital management and offered a contract for 3 months to assist with their waiting list management – that was 23 years ago! Waiting list management remains a passion of mine to this day.
What do you do in your downtime?
Cook, cook and cook for family, staff, neighbours and fundraisers. Also participate in many fundraising events e.g. Cancer Council, Women’s Refuge, Steptember etc.
Can you share a little-known fact about yourself?
Before starting work with NSW Health, I worked at a Service Station ‘pumping gas’. Also, I was born at Coffs Harbour Hospital (then called Sunnyside) and here I remain!!
What skill would you like to learn?
Fancy cake decorating and /or attend a cooking school in Italy.
What is the best advice you’ve ever been given?
From my mother – “do not spend your life accumulating money and assets, spend your time helping your fellow man especially those less fortunate than yourself – this way you will always be happy!!” And…guess whose always smiling now?
If you could have any super power, what would it be?
The power to make people stop smoking instantly without them having to go through the withdrawal etc.
South Eastern Sydney Local Health District (SESLHD) Advanced Recovery Orthopaedic Program
The Advanced Recovery Orthopaedic Program (AROP) is a patient centred, innovative model of care which targets a group of patients who would benefit from a fast track orthopaedic program. AROP is based on Enhanced Recovery After Surgery (ERAS) principles and support patients being discharged from the acute hospital setting within 24-48 hours following hip and knee replacement surgery.
The SESLHD Orthopaedic Surgeons conservatively estimate approximately 30% of the current elective waitlist for knee and hip replacement surgery will meet AROP criteria. The model focuses on integration and collaboration between clinicians to produce positive outcomes for patients and assist to meet financial and performance needs of SESLHD aligning with the NSW Strategic Plan.
The AROP is an example of the SESLHD Service Rationalisation process. It has been a clinician led quality improvement initiative driven via the SESLHD Surgical Clinical Stream. AROP effectively reduces the current length of stay by up to four days, allowing organisations the opportunity to review current service provisions in regard to waitlists, theatre times, patient flow and bed availability. AROP will reduce clinical variation through implementation of clinical pathways, guidelines and educational packages developed for patients and staff and by aligning service requirements designed to deliver world class care.
The SESLHD hospitals targeted to participate in the program are Prince of Wales (POW) and The Sutherland Hospital (TSH). POW commenced the program in August 2017 with a staged implementation plan. Within the first month, 14 patients have participated in the program undergoing knee and hip replacement surgery being discharged within 24-48 hours. The hospital has seen an acute hospital bed day savings of 35 days. The second month of the program is projected to exceed the first month’s volume and patients are now requesting to be part of the program.
The AROP patients who have participated in the program have expressed gratitude and complimented the program.
Dr Michael Solomon (Surgeon)
“The AROP program is an outstanding team effort to allow patients a quicker recovery, early hospital discharge and the ability to access home care after joint replacement surgery. The success of the program is due to the excellent collaboration between surgeons, anaesthetists, nursing, occupational therapy and physiotherapy staff whose aim is to optimise patient recovery from hip and knee replacement surgery”
Quote from Patients
“Fantastic Program, I would recommend to others (I’ve recommended the program to his brother who is out of area) “
“Fantastic to get home so early and be supported”
Quote from Physio
“A new way of looking at recovery for our patients”
Quote from Orthopaedic Clinical Nurse Concultant
“Great to see what we can achieve when we work as a team and include the patient in the process, encouraging patients to be active participants in their recovery”
AROP will create a paradigm shift. This model will support the review of surgical procedures within all specialties to develop fast track models for selected groups of patients who meet criterias set by clinicians.
South Eastern Sydney Local Health District (SESLHD) Surgical Dashboard
The South Eastern Sydney Local Health District Surgical Dashboard has been developed collaboratively by the SESLHD Surgical Stream and the SESLHD Business Intelligence Efficiency Unit. The objective of the dashboard was to create a “one stop shop” for surgical data to enhance strategic and operational decision making.
The dashboard presents key metrics including current wait list status, median wait times, operating theatre utilisation and emergency surgery access performance.
Theatre data is loaded into the dashboard from the Cerner eMR Surginet every 24 hours, and wait list data is loaded from the i.Patient Manager (IPM) software every 12 hours. Data is presented in a visual format, suitable for display in monthly and weekly team meetings. This automates a manual process previously attended to each month, enabling timely review of data along with greater transparency and engagement.
So far, the user group has responded enthusiastically to the dashboard development. Andrew Maxwell, Nurse Manager Admissions & Perioperative Services, Prince of Wales Hospital said that “the ability to follow the Surgical Services at each of the hospitals in our district with real time data will greatly assist decision making.”
The dashboard is in final stages of testing with deployment anticipated in October 2017, with roadshows across facilities in SESLHD in November 2017.
Royal Australasian College of Surgeons
Over the past four years the NSW Committee have developed Surgeons’ Month from an initial pilot, and although still evolving, we now have an interest filled group of events for all our Fellows, Trainees and International Medical Graduates (IMGs) to find interest in.
The aims for Surgeon's Month 17 are:
- Firstly there should be visibility of ongoing education and development for our Fellows, Trainees and IMGs.
- Secondly there should be visible support for the prevocationals who are coming through to become our colleagues.
- Thirdly, we should actively address issues that are relevant to our College.
- Fourthly, we should highlight and honour our peers for the work they do.
- Finally we should have a collaborative atmosphere throughout the whole of Surgeons’ Month, whether as a Fellow, IMG, Trainee, Medical student, Resident, other medical specialist, sponsor or other stakeholder.
Surgeons’ Month will have the same format as the previous two years with one major event per week as well as supporting other events, both in the NSW office and externally in NSW.
The NSW Committee looks for ongoing opportunity to benefit our Fellows, Trainees and IMGs, as well as other stakeholders within NSW, and Surgeons’ Month is the main flagship to undertake this.
We have five main events this year:
- Barriers to Surgical Innovation - Tuesday, 24 October 2017
Aimed at those with an interest in academic surgery and research. To register please email email@example.com
- Prep for SET - Saturday, 4 Novemeber 2017
Principally for Prevocational, but all are welcome. To register please email firstname.lastname@example.org
- Younger Fellow Preparation for Practice - Saturday 11 November to Sunday 12 November
For Younger Fellows looking to develop their practice.
- Women in Medicine - Wednesday, 15 November 2017
All welcome with an interest in leadership. To register please email email@example.com
- NSW Surgeons’ Evening - Tuesday, 21 November 2017
All Closing event of Surgeons’ Month with a panel discussion and also the Graham Coupland Lecture presented by David Little, all welcome. To register please email firstname.lastname@example.org
Please feel free to contact RACS NSW with any questions or comments:
Suite 1 Level 26 201 Kent Street Sydney
Phone: 02 8298 4500
New app and magazine help improve the surgery journey
The front foyer of Wollongong Hospital was transformed into a simulated Operating Theatre on Friday 14 July, to set the scene for the launch of two new and innovative patient resources developed by the Illawarra Shoalhaven Local Health District’s Division of Surgery.
The My Surgery Journey magazine and smartphone app are designed to help patients prepare for surgery by providing trusted, timely, essential and easy-to-understand information.
The idea for the new resources came from Division of Surgery Clinical Nurse Consultant, James Brinton, who said the launch was the culmination of 12 months of collaboration between staff and patients, who have worked together to design a solution to some of the common needs for patients having surgery.
“The magazine and app are education and information tools aimed at improving all stages of the surgery journey for patients, their families and carers, and staff. The resources provide detailed advice and information, ranging from what to do in the lead-up to your surgery right through to what to expect when you go home,” Mr Brinton said.
Division of Surgery Clinical Co-Director, Kate Fish said the new resources will also help reduce surgery cancellations by educating patients about the surgery process and the importance of arriving at hospital, ready and on-time.
“Unfortunately day-of-surgery cancellations can occur when a patient arrives late to hospital or hasn’t followed pre-surgery instructions. This negatively impacts everyone involved; including the patient, our allocation of surgery resources and staff and, on a broader scale, our surgery waiting lists,” Ms Fish said.
“The app and magazine are great ways to empower and educate our patients and help ensure they have undertaken the necessary preparations ahead of their surgery.
“Having patients who are informed and know what to expect also leads to less pre-operative anxiety, which has been linked to faster recovery and a shorter length-of-stay in hospital,” she said.
My Surgery Journey smartphone app introduces Sir Gerry (phonetically: sur-gery), a light-hearted and relatable animated character, designed to simplify the surgery journey and give patients information and instructions in a relaxed and fun way.
Tell us what you think
What did you think of this edition of the Surgery Newsletter?
Do you have some feedback on one of our stories, or do you have a story idea? We would love to hear from you.
Email the Editors at:
Ms Melinda Pascoe
Phone: (02) 9391 9557
Ms Chrissie Crawford
Phone: (02) 9391 9394