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
The last few months have been an extremely busy period for NSW Health. Despite increases in volume, the percentage of patients who have their surgery completed within their clinically recommended timeframe is at or slightly below target for all three categories.
The April 2018 Elective Surgery Access Performance (ESAP) year to date results are:
- Category 1: 100% (Target 100%)
- Category 2: 97.3% (Target 97%)
- Category 3: 96.4% (Target 97%)
At the end of April 2018, the total number of overdue elective surgery patients was 638, an increase from 524 overdue patients for the same period in the previous year. The surgical specialties with the highest number of overdue patients were Orthopaedics 24, Urology 143 and ENT 99 patients.
The ESAP Performance Monitoring and Recovery Support Programs are assisting sites that have significant numbers of overdue patients. This includes weekly reporting and attendance at teleconferences to discuss the number of overdue patients and local strategies to address identified issues.
The most recent Bureau of Health Information Quarterly Report (October to December 2017) highlights included:
- Overall, 97.5% of elective surgical procedures were performed within clinically recommended timeframes
- There were 55,872 elective surgical procedures performed in NSW public hospitals during the quarter.
- The median wait times were 10 days for urgent procedures (unchanged, compared with the same quarter last year), 44 days for semi-urgent procedures (up one day) and 210 days for non-urgent procedures (down two days).
These results are an outstanding achievement and a credit to the ongoing hard work and dedication of the many staff in the Districts and Networks. Congratulations! Excellent work.
Executive Director, System Purchasing
Elective Surgery Waiting Time Coordinators and Booking Officers Professional Development Day
On Friday 13 April 2018, the System Purchasing Branch Surgery Team hosted the 2nd Annual Elective Surgery Waiting Time Coordinators and Booking Officers Professional Development Day.
A total of 14 speakers from the Ministry of Health and local health districts presented on a range of models and initiatives to increase access to surgery. The day was very well attended with 135 Registrations from across the local health districts, speciality health networks and NSW Health Pillars. It provided the opportunity for networking and the sharing of ideas amongst those attending.
The System Purchasing Branch is grateful for the staff and their executive from across our health system for their contributions to this event and for sharing their initiatives and learnings.
The Professional Development Day contributes to our strategic priorities including Priority 2 under the NSW Health Strategic Priorities 2017-18 to provide world class clinical care where patient safety is first and the NSW State Priority to increase on time admissions for planned surgery, in accordance with medical advice.
The evaluation survey found:
- 46% rated the event as excellent, 50% as very good and 4% as average.
- 36% found the content presented at the event as extremely relevant, 56% as very relevant and 8% as somewhat relevant.
- 32% found the speakers were extremely engaging, 58% as very engaging and 10% as somewhat engaging.
- 93% would adopt the projects, process and ideas in their own district and 6% would not.
- 92% thought this event provided enough opportunities to network with other colleagues.
Elective Surgery Liaison Nurses improving surgery performance at Wollongong Hospital
In 2015, the Elective Surgery Liaison Nurse (ESLN) role was introduced to Wollongong Hospital to support elective surgery and the day to day management of the waiting lists and the patients on them. The ESLNs ensure that approximately 125 patients are ready for surgery each week and plan the care of each and every patient regardless of if they attend a pre-admission clinic or not. Approximately 50% of patients do not attend a pre-admission clinic and are exclusively managed by the ESLN.
The ESLN position is graded as a Clinical Nurse Specialist 2, and requirements include post graduate qualifications, and currently all but one have critical care backgrounds. They each are assigned a portfolio of specialties, and manage the waitlists for these specialties. They work closely with their individual surgeons, and offer extra lists, extended sessions, transfer of care to other surgeons and other strategies that will increase access to care for patients. At the same time they also liaise closely with allied health, community, family, pre-admission clinic, operating theatres, patient flow managers, and of course the patients themselves in regard to pre-operative planning. The ESLNs also follow up all patients who are listed as ‘not ready for care’, and work efficiently to either ensure they are fit for surgery, or work with the patient, the surgeon and GP to determine if surgery is still the best treatment option for the patient.
Since the ESLN role has been introduced there has been an increase in the advocacy of elective surgery patients, an improvement in patient knowledge about their surgery, a reduction in day of surgery cancellations, an increase in theatre utilisation as well as an improvement in the management of patients listed as not ready for care. The ESLNs have also played an integral role in implementing initiatives such as improving patients Haemoglobin preoperatively, implementing Enhanced Recovery After Surgery (ERAS) for colorectal patients and a prehabilitation program for patients who have time to optimise their health prior to their date of surgery.
Elective surgery by the nature of the word implies people have a choice about their surgery. However, it’s important to remember that these patients do not choose to have breast cancer, kidney stones, severe osteoarthritis or the many reasons for requiring elective surgery. Any delay to access to care can result in poorer outcome for patients, so we work to advocate for patients, ensure access to care is timely and we also do our best to ensure our patient’s preoperative experience is as positive and smooth as it can be.
For further inquiries please contact:
Kari Fedder, Nurse Unit Manager, Surgical Admissions and Elective Surgery Waitlist, Wollongong Hospital
The Royal North Shore Surgical, Education, Research & Training Institute
The Royal North Shore (RNS) Surgical, Education, Research and Training (SERT) Institute was established as an academic department within the RNS hospital Division of Surgery and Anaesthesia in 2017. This was in response to the NSW State Health Plan - Towards 2021 strategy to support and harness research and innovation.
The Institute’s vision is to build a bridge between academic learning and professional practice of surgery at the RNS hospital, and as a result, improve outcomes for our patients. It is also working closely with the University of Sydney Northern Clinical School to help achieve this.
The Institute is run by a full-time manager, Shelly Dhaliwal, with strategic advice from the two Co-Directors, Professor of Surgery Northern and Head of Upper GI Surgical Unit Professor Thomas J Hugh, and the Professor of Orthopaedic Surgery (in the process of being appointed).
The Institute is collaborating with all RNS hospital surgeons, but especially with those who are actively involved in teaching, education, research and mentoring activities. Each surgical department was engaged in a massive consultation from July -November 2017 to help determine priorities, barriers and challenges when engaging in academic activities on the campus. Nine out of twelve surgical departments responded (75.0%), which demonstrates the high value they place on academia as part of professional practice. The Institute is now finalising its work plan based on these responses, and will regularly report on the identified key performance indicators to the Northern Sydney Local Health District and RNS hospital executives, and the surgical departments.
For further inquiries please contact
Shelly Dhaliwal, Manager, SERT
New Surgical Services Taskforce Manager at the Agency for Clinical Innovation
The Agency for Clinical Innovation (ACI) is pleased to announce that Crystal Burgess was appointed as the Surgical Services Taskforce (SST) Manager from April 2018. Crystal has been working with ACI as the Project Officer for Surgery, Anaesthesia and Critical Care portfolio, supporting initiatives across the surgery, anaesthesia, intensive care, urology and burns networks.
Prior to joining ACI, Crystal worked with the Bureau of Health Information in their Corporate and Business Development unit. She has a clinical background in nuclear medicine technology, and worked for several years at Prince of Wales Hospital.
Crystal looks forward to continuing to work with clinicians and managers in NSW to deliver high quality patient care and surgical services.
For further inquiries please contact
Crystal Burgess, Manager, Surgical Services Taskforce
Phone: 0410 550 359
[back to top]
Green Operating Theatres Workshop: Let’s make it easy being Green!
Monday 28th May 2018 Time
Agency for Clinical Innovation Building, Chatswood (Travel assistance is available for those from rural districts)
In Australia – 7% of Australia’s total carbon fit-print can be attributed to the health care industry with 44% of emissions being from hospitals. The Perioperative setting uses large amounts of energy, consumables and produce excessive waste – estimated at over a quarter of all hospital waste.
This workshop will be a mix of speakers and workshop with the idea for participants to provide feedback on what they would need to reduce waste produced in hospitals and how best the Agency for Clinical Innovation can assist. The title is “Green Operating Theatres” – however the learnings and opportunities are transferable to other areas of the hospital and we have speakers lined up from the University of Sydney, Healthshare and local hospitals.
For further inquiries please contact
Sarah Jane Waller, A/Anaesthesia and Perioperative Care Network Manager, Agency for Clinical Innovation
Operating Theatre Productivity Index
The Agency for Clinical Innovation has been working to develop an application to measure and monitor productivity of operating theatres in NSW public hospitals. The app, hosted by the Activity Based Management (ABM) team, is now live in three pilot sites, with access managed by the ACI. The app will be progressively rolled out in coming months to Local Health Districts for theatre managers, district and network performance units, Heads of Department and Directors of Surgery to access information and apply to their local environment.
The Operating Theatre (OT) Efficiency Guidelines were published in 2014, providing guidance on measuring and monitoring efficiency through enhanced understanding of theatre management, capacity and costing. During the development of the Guidelines, it was identified that a standardised method of assessing productivity in NSW operating theatres would support OT managers to make informed decisions about their service. The Operating Theatre Productivity Index (OTPI) was subsequently developed, measuring productivity of elective surgery using routinely captured administrative data.
The Index calculates the patient activity produced for every $1,000 of surgery resources spent. It includes nursing, anaesthetist and surgeon staffing costs, as well as non-labour operating theatre costs such as consumables, equipment, pharmaceuticals and ward costs associated with the surgical episode of care. To allow comparable assessment of surgical case-mix between specialties or across peer hospitals, the Index also weights patient complexity.
The Index allows an individual to access results for their own hospital to compare the productivity of surgical sessions:
- Over time
- With other hospitals in the district
- Between surgical specialties
- With peer hospitals
- To the average of all hospitals across NSW
The Productivity Index is intended to provide a better understanding of the business of undertaking surgery. It is one of the metrics that can be used to create the picture of how an operating theatre works, and complements existing metrics available to measure activity, efficiency, cost, safety and clinical outcomes in the OT.
For further inquiries please contact
Crystal Burgess, Project Officer Surgery & Anaesthesia, Agency for Clinical Innovation
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