Hello everyoneWelcome to the September 2016 edition of Surgery News.
As you may be aware, a key state priority is to increase on-time admissions for planned surgery, in accordance with medical advice and the Government has committed significant additional resources in this year’s budget. I am therefore pleased to note that the Elective Surgery Access Performance (ESAP) result for the period April to June 2016, demonstrated that 97% of elective surgery in NSW was performed on time - 100% of urgent surgery (Category1), 97% of semi –urgent surgery (Category 2) and 96% of non-urgent surgery (Category 3). These results have been stable for all urgency categories for the same quarter for the past three years.
To date, 2016 has been an extremely busy year for the Surgery Teams in the Ministry of Health and in the local health districts and health networks. The Ministry of Health Surgery Team are currently reviewing the draft Waiting Time and Elective Surgery Policy, assisting sites with performance issues and working closely with the EDWARD/OPERA Team and the Pilot sites.
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.
RegardsElizabeth Wood
It is with great sadness to share the news of the loss of our colleague and friend, Judy Willis, who died peacefully at home.
Judy will be deeply missed by her friends and colleagues here at the Ministry of Health, and by the many clinicians and wait list managers with whom she worked so tirelessly to support to ensure access to surgical services for all patients across NSW.
Judy worked within the Ministry for over 10 years as our Principal Policy Advisor for Surgical Services, and was widely respected across the NSW Health System, not only for her extensive knowledge and expertise, but also for her wonderful nature and positive attitude.
She had a passion for Perioperative Nursing and was instrumental in the introduction of the Predictable Surgery Program in NSW and an active member of the Surgical Services Taskforce for many years.
Judy will be missed by everyone whose lives she touched.
The Surgical Activity during Christmas /New Year Policy (PD2012_038) requires local health districts and health networks to submit a surgical services plan, for the Christmas/New Year period, to the Ministry by the end of October each year.
local health districts and health networks are required to ensure that urgent and emergency surgery requirements are able to be met and that elective patients do not exceed the recommended clinical priority timeframe at the end of each month in order to achieve the Elective Surgery Access Performance (ESAP) targets for planned surgery.
The district and network surgery plans must ensure overdue patients in Categories 1, 2 and 3 are minimal by the end of December 2016. In most local health districts and health networks, this will require that full operating theatre activity continues through to just prior to Christmas in December, and resumes in mid-January 2017. Any period of reduced surgical activity prior to Christmas and any reduced activity in excess of three weeks over the December/January period will require formal approval from the Deputy Secretary, System Purchasing and Performance.
Activity plans for the 2016-2017 Christmas/New Year period have been requested from each district and network and are due to be submitted using the supplied template to the Ministry of Health by Friday 28 October 2016.
If you have any questions or require any assistance or support with this request, please contact:
Ms Melinda Pascoe, Principal Policy Officer, SurgeryPhone: (02) 9391 9557Email: mpasc@doh.health.nsw.gov.au
Our project “Emergent Surgery: Why The Wait?” will address current delays for patients identified as requiring emergent surgery, within 24 or 72 hours, where the delays result in an increased length of stay due to delay to theatre and / or discharge.
Our aim is to improve the time to operating theatre for our patients without compromising their safety. Delays to Operating Theatre results in an increased length of stay, extended fasting time, poor patient experience of our service and reduced patient outcomes. Using the redesign methodology the project is now in the implementation stage.
The solutions we are implementing include education regarding emergency surgery categories, electronic whiteboard, patient information pamphlet, electronic emergency surgery referral, pathway and fit for surgery checklist.
For more information please contact:
Shirley Walker, Project Officer, Whole of Health ProgramPhone: (07) 5506 7427Email: shirley.walker@ncahs.health.nsw.gov.au
The Agency for Clinical (ACI) Innovation Surgery Anaesthesia and Critical Care Portfolio in conjunction with the Ministry of Health recently held its 7th Surgery Redesign Training Program.
This 5-day face to face course focused on the development of foundational project management, change management and clinical redesign skills. In response to feedback from previous years, a presentation day in November has been added to the program to provide an opportunity for participants to feedback to the other participants together with some invited guests, on project progress and next steps.
The program, which utilises proven redesign methodology, aims to equip front line clinical and managerial staff from NSW surgical services, to identify issues impacting on their service and develop and implement sustainable change to improve the way care is delivered.
The benefits of this 5 day course:
The importance of patient and consumer engagement was also demonstrated to participants. Participants were introduced to practical methods as to how to engage consumers.
The focus for this year’s program was Operating Theatre Efficiency and this year’s school attracted 22 participants from 9 local health districts all with operating theatre efficiency projects.
Participants had the opportunity to apply the learning to their workplace project during the face to face days, and completed key elements of their project plan with the support of staff from the Surgery, Anaesthesia and Critical Care and Centre forHealthcare Redesign portfolios at the ACI as well as Ministry of Health.
Participants will receive ongoing support from the ACI and their local health district Redesign leaders.
The program was evaluated daily and the feedback was extremely positive. Examples of feedback were “Very informative.”, “The ACI Centre for Healthcare Redesign team have been great!” & “Really enjoyed the mix of group work and activities.”
Participants will receive ongoing support from the ACI, Ministry of Health and their local Redesign leaders.
Gavin Meredith - Manager, Surgical ServicesPhone: (02) 9464 4644 Email: gavin.meredith@health.nsw.gov.au
In 2015, the Agency for Clinical Innovation (ACI) commenced a review of the 2007 NSW Health Pre Procedure Preparation Toolkit. Building on that previous work, the Perioperative Toolkit has been prepared to ensure that the best evidenced care is provided to patients undergoing a surgery/procedure with anaesthesia by describing a framework to optimise perioperative structures, processes and outcomes. The toolkit was developed by a working group of expert clinicians, the Ministry of Health and other local health district staff experienced in perioperative care. Consultation on the draft Perioperative Toolkit closed on 12 September. The ACI’s Perioperative Toolkit Working Group is currently reviewing feedback from local health districts and health networks and making final revisions. The toolkit is scheduled to be released in October 2016.
The ACI Anaesthesia Perioperative Care Network is holding a workshop on Tuesday 8 November 2016. In particular, the workshop will focus on the Perioperative Toolkit (2016) and will provide an opportunity for clinicians and staff working in anaesthesia and/or surgical services to network with their peers and workshop ideas on local solutions for implementing the toolkit.
Expressions of interest can be registered with the Agency for Clinical Innovation.
Support is available for rural staff to participate in the workshop.
Ellen Rawstron - Manager, Anaesthesia & Perioperative Care NetworkPhone: (02) 9464 4641Email: Ellen.Rawstron@health.nsw.gov.au
For the period April to June 2016, the Bureau of Health Information reports that a total of 58,583 elective surgical procedures were performed, 3,937 (7.2%) more than in the same quarter last year. Of all the elective surgical procedures performed this quarter, 20.9% were categorised as urgent, 31.7% as semi-urgent, and 42.8% as non-urgent. A further 4.6% were categorised as staged.
Orthopaedic surgery and ophthalmological surgery were the specialties with the most patients waiting at the end of the quarter. Together, these specialties made up 48.7% of all patients waiting for elective surgery in NSW public hospitals. Cardiothoracic surgery and medical (non-specialist) surgery had the smallest number of patients waiting.
Congratulations everyone on another successful year for surgical services across NSW Health! The total number of overdue elective surgery patients across all categories in NSW was 177 (June 2016). This is a 79% reduction compared to the same time last year and the lowest result achieved since June 2011. It is also a significant reduction from 4,744 patients at June 2007, 1,197 at June 2010 and 731 at June 2013.
NSW elective surgery performance continues to be strong and the best in the country, with maintenance requiring constant vigilance. These results are a significant achievement and a real credit to the staff in our busy hospitals who are working towards all our patients being treated within their clinically recommended timeframes.
The Surgery Access Line (SAL) is fully operational. We want to ensure all patients have timely access to health care and are admitted to hospital according to their clinical need.
The SAL has been established to provide an information service regarding booked admissions to NSW Public hospitals and to enquire on patients behalf and investigate surgery options that are available.
The Surgery Access Line staff provide information regarding current waiting time and will investigate options for earlier treatment.
The Waiting Time and Elective Surgery Policy (PD2012_011) states that surgery should meet an identified clinical need to improve the physical health of the patient.
The approval of the local health district or health network Program Director of Surgery, in consultation with senior management should be sought by the referring doctor before cosmetic and discretionary procedures are undertaken in any public hospital facility.
The referring doctor should document on the Request for Admission form, at the time a patient is referred, objective medical criteria supporting the decision for surgery for all procedures that may be considered cosmetic or discretionary. This requirement supports appropriate documentation of clinical decision-making and the review process.
Where there is doubt about the nature of the proposed surgery, the request should be referred to the local health district or health network Program Director of Surgery for review prior to the patient being added to the waiting list.
The patient should be advised when the Recommendation for Admission is going through the approval process.
A list of surgical procedures that should not routinely be performed in public hospitals in NSW, unless there is a clear clinical need to improve a patient’s physical health, is included on page 6 of the policy.
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 PascoePhone: (02) 9391 9557Email: mpasc@doh.health.nsw.gov.au
Ms Chrissie CrawfordPhone: (02) 9391 9394Email: ccraw@doh.health.nsw.gov.au
