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 Deputy Secretary

Deputy Secretary, System Purchasing and PerformanceHello 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.

Susan Pearce

The Ministry of Health Surgery Team

Ministry of Health Surgery team 

The Ministry of Health Surgery Team are in the System Purchasing Branch. From left to right in the photo are:

Melinda Pascoe, A/Principal Policy Advisor - Surgery

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 9557
Email: mpasc@doh.health.nsw.gov.au

Elizabeth Wood, Executive Director, System Purchasing Branch

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 9880
Email: ewood@doh.health.nsw.gov.au

Annette Marley - A/Senior Manager, Purchasing and Performance

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 9932
Email: amarl@doh.health.nsw.gov.au

Bankstown Hospital Perioperative Services

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.

Cessation of On Call Night Duty staff

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.

Additional operating theatre sessions

In addition to the existing Emergency Theatre that is staffed 24 hours 7 days a week. The following sessions have been introduced:

  • E2 list: Emergency surgery sessions Monday/Wednesday/Friday – 17.00 to 21.00 hrs to facilitate emergency surgery access and reduce delays due to surgeon unavailability
  • Elective Surgery Access Performance (ESAP) sessions. Tuesday /Thursday – 13.00 to 17.00 hrs to maintain surgical access and limit the number of overdue elective surgical patients
  • Subacute – Clinical Priority Category (CPC) 1 and Inpatients – one session per week
  • Local Health District initiatives:
    • Low Volume Cancer Surgery sessions
    • Paediatric ENT sessions x 3 per month
    • Ophthalmology Waitlist reduction

Communication and planning strategies

“Red Line” meetings

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.

Weekly Wait List meeting

This meeting reviews upcoming theatre sessions. The focus is to improve care of the surgical patients and decrease cancellations.


  • Waiting List Manager
  • Waiting List Supervisor
  • Operating Theatre NUM
  • Perioperative Nurse Manager
  • Anaesthetic NUM
  • Endoscopy NUM
  • Anaesthetic Secretary
  • Patient Flow Manager

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.

Weekly Wait List meeting with General Manager

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.


  • General Manager
  • Director of Surgery
  • Director of Medical Services
  • Operational Nurse Manager
  • Waiting List Manager
  • Waiting List Supervisor
  • Perioperative Nurse Manager
  • Patient Flow Manager

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.

Monthly meeting

This meeting involves a review of the data in Activity Folder. The reports reviewed are:

  • Activity Report
  • E2 Operating Session utilisation Report
  • Emergency Postponements per month (Operating Theatre and Endoscopy)
  • Weekend Emergency Session Utilisation Report
  • Day of Surgery Cancellations
  • Unplanned/Planned return to the Operating Theatre
  • First Case Start Times
  • Low Volume Cancer Surgery (LVCS)
  • ENT Paediatric Wait List Reduction
  • Ophthalmology Wait List Reduction
  • 23Hour Short Stay Unit
  • Doctor Utilisation report by month

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.

More information

For further information please contact:

Eleanor Halvey
Nurse Manager Perioperative Services
Bankstown-Lidcombe Hospital
Phone: (02) 9722 8435
Switchboard: (02) 9722 8000 Pager: 28094
Fax: (02) 9722 8455
Email: Eleanor.Halvey@sswahs.nsw.gov.au

Operating Theatre Self-Assessment Tool

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.

  1. The section on Efficiency Metrics describes operating theatre measures and performance indicators that reflect efficiency and productivity and responsibilities for data collection.
  2. The Operating Theatre (OT) Costing section outlines costs associated with the different elements of surgery and feasible costing measurements and responsibilities.
  3. The Whole of Surgery section provides advice on the responsibilities of managers from preadmission through to the operating theatre suite and discharge, effective structures for collaboration between management and clinical staff, and developing effective frameworks that promote efficiency in patient throughput and quality care.

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.

More information

For further information please contact:

Gavin Meredith - Manager, Surgical Services
Phone: (02) 9464 4644
Email: gavin.meredith@health.nsw.gov.au

Ellen Rawstron - Manager, Anaesthesia and Perioperative Care Network
Phone: (02) 9464 4641
Email: ellen.rawstron@health.nsw.gov.au

Sarah-Jane Waller - Ophthalmology Network Manager
Phone: (02) 9464 4645
Email: sarahjane.waller@health.nsw.gov.au

Leanne Creighton - SACC Project Officer
Phone: (02) 9464 4661
Email: leanne.creighton@health.nsw.gov.au

EDWARD Business Implementation (EBI) ProgramOPERA logo

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.

Forward planning reports in OPERA

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:

Forward planning report timeline 

OPERA report screen shot  

Special thanks to Cathy Barnett from Murrumbidgee LHD for her input these reports.


More information

For more information on the programs there is online information as well as local and program contact information.

Online information for NSW Health staff

LHD contacts

Program team members

Program Director - Robert Coppolino
Phone: (02) 8918 1601
Mobile: 0402 881 668
Email: robert.coppolino@health.nsw.gov.au

Solutions Architect - James Prior
Phone: (02) 8918 1606
Mobile: 0448 789 939
Email: james.prior@health.nsw.gov.au

Senior Business Analyst / Training Lead - Jillian Ashby
Mobile: 0458 573 912
Email: jillian.ashby@health.nsw.gov.au

Change Manager - Kate Holz
Phone: (02) 8918 1608
Mobile: 0412 360 860
Email: kate.holz@health.nsw.gov.au

From Ice to Nice: Reducing the incidence of Inadvertent Hypothermia in the perioperative patient

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.


  • Reduces incidence of inadvertent hypothermia in surgical patients
  • Improves wound healing and recovery time
  • Reduces risk of haemorrhage, myocardial ischaemia and post-operative infections
  • Reduces length of stay in hospital
  • Reduces patient anxiety and increases comfort during their hospital stay
  • Reduces costs associated with managing post-operative complications


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.


  • EasyWarm® active self-warming blankets were provided to patients on arrival to the hospital and 45 minutes prior to surgery. The blanket was placed on their bed during surgery and stayed with the patient during recovery.
  • Forced-air warming was initiated in theatre once patients were positioned for surgery.
  • Bair Hugger temperature management systems and warm fluids were implemented if the patient’s temperature was below 36 degrees Celsius on admission to the hospital.
  • After consultation with the manufacturer, information brochures on self-warming blankets were given to patients who were participating in the trial. This provided valuable information on the blanket and helped them understand the aims of the project.
  • Patients were also educated on the importance of keeping warm, during pre-operative phone calls.
  • The manufacturer provided face-to-face education sessions on pre-warming strategies to ward and theatre staff, as well as posters and user guides for patients.
  • Pre-warming strategies to maintain normothermia prior to surgery were incorporated in management policies at Central Coast Local Health District.

Project status

Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

January 2015 to February 2016

Implementation sites

  • Operating theatres, Gosford Hospital
  • Operating theatres and Surgical Admissions Centre, Wyong Hospital



  • An audit conducted prior to the project showed that 52% of patients arrived in the recovery unit following surgery with inadvertent hypothermia.
  • A second audit conducted in July 2015 found that 65% of patients had one or more hypothermic events during their surgical intervention and that 15% of patients arrived at the hospital in a hypothermic state.
  • Preliminary results following project implementation showed a reduction in hypothermia from 65% in July 2015 to 35% in February 2016.
  • The number of patients arriving in the anaesthetic bay with hypothermia reduced from 15% in July 2015 to 1% in January 2016, in Gosford operating theatres alone. As of April 2016, Wyong data is still being collected.

Lessons learnt

  • It is extremely important that communication is thorough and extensive.
  • Data speaks louder than words. We found that we got a better response from sharing data, than simply stating there may be an issue.
  • Using champions to spread the word and support the project made the process easier.

Further reading

More information

For further information please contact:

Tracy Kerle
Nurse Manager, Perioperative Services, Gosford Hospital
Central Coast Local Health District
Phone: 4320 3471
Email: tracy.kerle@health.nsw.gov.au

Out and About

Bankstown and Wagga Wagga surgery booking teamsStaff 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

Current as at: Thursday 29 September 2016
Contact page owner: System Purchasing