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.

Previous newsletters

In this edition

Message from the Executive Director, System Purchasing Branch

Hello everyone,Elizabeth Wood

I want to take this opportunity to thank you all, for your hard work over the past 12 months. NSW Health has experienced one of its busiest years and has delivered the highest number of elective surgeries on record. Without the dedicated teams in all NSW public hospitals, we could not have delivered these services for our patients.

In 2018-19 NSW delivered 228,871 elective surgery procedures, this was 2,372 more than the previous year. Overall, 97% of patients had their surgery within the recommended timeframe. On time performance remains strong in NSW and is the best in the country, despite NSW performing 30% of the national volume of elective surgery.

The 2018/2019 Elective Surgery Access Performance (ESAP) results were:

  • Category 1: 99.9% (Target 100%)
  • Category 2: 97.1% (Target 97%)
  • Category 3: 95.7% (Target 97%)

The Ministry of Health Surgical Services Team continues to assist hospitals to improve access to elective surgery and reduce the number of overdue patients. This year Surgical Services Team visited a number of Districts and Networks across the state to review current practices and make recommendations to improve efficiencies and provide education and training sessions.

Thank you again and I wish you all the best over the holiday season.

Elizabeth Wood
Executive Director, System Purchasing.

Bi-monthly education for booking officers and waitlist managers

We have recently changed the format of the Elective Surgery Waiting List Booking Officers and Waitlist Managers Meeting. This meeting now provides a learning opportunity with a focus on providing education with the chance for participants to ask questions and to share information.

So far the topics have included ‘Managing Clinical Priority Categories’, ‘Surgical Services Taskforce Dashboard Overview’ and ‘Managing Transfer of Patients to Avoid Exceeding Clinical Priority Timeframes’. After each presentation there is a question and answer session for participants to cover topics around elective surgery bookings that are currently arising in their workplaces.
The education sessions are guided by the questions that we are often asked in the Ministry of Health Surgical Services Team. We are always looking for suggestions of topics and invite you to submit suggestions.

Are there booking officers in your department that are not on the meeting invite list? Contact us to ensure your colleagues don’t miss out.

For ideas, invites and further inquiries

Melinda Pascoe, Prinicpal Policy Officer, Surgical Services, NSW Ministry of Health
Phone: 9391 9557

NSW Elective Surgery Managers and Waiting Time Coordinators Professional Development Day 2019

The annual professional development day was held on the 13th of September at the Kirribilli Club in Sydney. The event was very well attended with more than 120 attendees from Local Health Districts, Speciality Health Networks and pillar organisations.
A total of 14 presentations were made by speakers from the Ministry of Health and Local Health Districts including initiatives to increase access to surgery and improve processes.

NSW Ministry of Health organise this professional development day annually to provide surgery managers and booking officers from across NSW the opportunity to get together, learn about successful projects, share ideas and connect with each other in the name of improving processes and access to surgery for patients in NSW.

Feedback has been very positive from the 2019 event where 98.5% rated the event as very good or excellent. 86.4% of attendees would adopt the projects, process and ideas presented on the day in their own district, while 98.6% would recommend the professional development day to their colleagues.

Have you been working on a quality improvement or redesign project at your hospital? We would love to hear about it and encourage you to present at the 2020 professional development day. If you are interested in presenting, get in contact with us.

For further inquiries

Melinda Pascoe, Prinicpal Policy Officer, Surgical Services, NSW Ministry of Health
Phone: 9391 9557

Christmas cooking

Here are a few gift ideas, with acknowledgement to Taste, to send your guests home with this Christmas.

Sweet and Smokey Nibble Mix

Sweet and Smokey Nibble Mix

Ingredients

  • 2 teaspoons smoked paprika
  • 1 teaspoon ground cumin
  • ½ teaspoon sea salt
  • 30g butter
  • 3 tablespoons of maple syrup
  • ¾ cup raw cashews
  • 2 cups mini pretzels
  • ½ cup raw almonds
  • ½ cup raw peanuts

Method

  1. Preheat oven to 180C and line a baking tray with baking paper
  2. Combine paprika, cumin and salt in a small bowl
  3. Melt butter in a saucepan over a low heat cook for 2 minutes, stir in maple syrup and cook for 1 minute. Remove from heat
  4. Stir in spice mixture then pour into a large heatproof bowl. Add the pretzels and nuts and toss to coat.
  5. Spread the nut mixture over the prepared tray. Bake, stir occasionally for 10-12 minutes or until golden. Remove the tray from the oven and allow nut mixture to cool completely. Serve

Gingerbread Brownies

Gingerbread Brownies

Ingredients

  • 250g unsalted butter, chopped
  • 300g dark chocolate
  • 4 eggs
  • 200g plain flour, sifted
  • 330g firmly packed brown sugar
  • ½ teaspoon baking powder
  • ½ teaspoon ground cinnamon
  • ½ teaspoon ground ginger
  • ½ teaspoon ground nutmeg
  • 35g cocoa, sifted
  • Icing sugar to dust

Method

  1. Preheat oven to 170C. Grease and line a 20cm square cake pan
  2. Melt butter and 200g chocolate in a heatproof bowl set over a pot of simmering water – don’t let the bowl touch the water! Stir until smooth and set aside to cool slightly
  3. Add eggs, 1 at a time to the chocolate mixture and beat well after each addition until combined
  4. Add the flour, sugar, baking powder and spices, then fold in the cocoa. Spread the batter into the pan and bake for 25 minutes or until just set. Cool in the pan and then turn out and cut into squares
  5. Melt the remaining 100g chocolate and allow to cool slightly
  6. To serve, dust brownies with icing sugar, then drizzle with melted chocolate

Surgical services team update, System Purchasing Branch

Welcome back to Chrissie Crawford who has enjoyed a career break over the last year. Chrissie will join Melinda in the Surgical Services Team in January 2020 and will continue to work on projects within the System Purchasing Branch.

Vincent Salomon
Vincent Salomon has finished his secondment with the Ministry of Health and will return to his role as Waitlist Manager at Sutherland Hospital. Vincent is a self-described bureaucratic ‘triple threat’ combining excellent ability, humour and cooking. He has been an integral part of the surgery and broader Ministry teams this past year and we have appreciated his expertise and passion. Vincent will be sorely missed.

Update: Increasing Access to Cataract Surgery Forum

The Increasing Access to Cataract Surgery forum was hosted by the NSW Minister for Health and Minister for Medical Research at Parliament House on 27 August 2018. This half day workshop brought together expert clinicians, health service managers and executives to identify challenges for accessing cataract surgery, successful models for improving access, and recommendations for implementation.

The report from the forum included eight action items for implementation.

Development of an electronic referral system for Outpatients – eReferral

Status: Progressing

eHealth have formed the Integrated Care Portfolio to work with Districts/Networks and the Ministry of Health on a state wide solution for eReferral. A workshop was held on 31 July 2019 that brought stakeholders together to identify business requirements and develop a coordinated approach.

Review of Business Rules for the management of Ophthalmology Outpatient lists including out of area referrals for cataract surgery

Status: Complete

The ACI Ophthalmology Network has completed a report and provided it to the Ministry. It is currently being reviewed and will be used as a reference to inform future directions. As part of a broader piece of work, NSW Health has commenced a survey of Outpatient Services across the state. Ophthalmology Services will be included as part of this review and will assist in determining how clinics are delivered in line with the Outpatient Framework.

Development of a standardised Outpatient Referral Form

Status: Complete

Following a consultation process led by the Ophthalmology Network a standardised referral form has been completed. Planning for the trial of the cataract referral form is underway. The form will be trialled initially at Sydney Eye and Prince of Wales Hospitals in South Eastern Sydney Local Health District.

Development of model of care and key principles for high volume day surgery cataract services

Status: Complete

The ACI Ophthalmology Network utilised the existing NSW Health High Volume Short Surgical Short Stay (HVSSS) Toolkit to support this work, in addition to reviewing high volume cataract surgery models. The report has been completed and provided to the Ministry. It is currently being reviewed and will be used as a reference to inform future directions.

Impact analysis of expediting access for second eye surgery

Status: Progressing

Initial data has been reviewed by the Ministry. Additional data and scenario modelling is required to fully understand the implications, consider the options and develop recommendations. This additional work has commenced.

Review of ophthalmology clinics in line with key principles of the Outpatient Framework

Status: Complete

NSW Health has completed a survey of a sample Outpatient Services across the state, including Ophthalmology services. The survey has provided baseline data to assist in focussing the strategy for improving the management and delivery of outpatient services in NSW.

Gap analysis of innovation and research currently occurring in NSW, Australia and internationally for cataract service delivery models

Status: Complete

Advice from the George Institute has been received. While there is substantial observations and data about the impact of cataract, there are very few randomised controlled trials internationally which have evaluated the cost-effectiveness of expediting cataract surgery.

Future directions from research that will be considered by the Ministry would include those related to cataract surgery planning and efficiency.

Provision of funding for Research

Status: Complete

The Translational Research Grants Scheme (TRGS) is an important part of NSW Health’s efforts in harnessing innovation and research capacity to improve health service delivery. The scheme is currently being evaluated. Calls for the next round of expressions of interest will be announced in 2020. 

Update from the EDWARD Business Implementation Program (EBI)

The EDWARD Business Implementation program has made significant progress over the past 12 months. The program has been working with a range of stakeholders including Districts, Networks, pillar organisations and the various branches within the Ministry of Health. Together with the Ministry EBI Transition team, the stakeholders have completed a wide range of transition readiness assessments and progressing with planning & executing extract remediation and other transition activities.

In October this year, the program released the Local Reporting Solution (LRS) Sandpit - this provides our stakeholders with an opportunity to review the structure of the reporting tables and how the data is planned to be delivered. As a collaborative exercise, feedback from stakeholders are being collected and upgrades to the LRS Sandpit is being made progressively towards establishment of the final LRS product.

The Program has also successfully redeveloped the former OPERA Wait List reporting tool in Power BI, currently being tested by a number of users. This enhancement brings additional features, improved visualisations and an ease for future enhancements.

The CERNER Wait List Optimisation Program which will deliver the Wait List extract for EDWARD and additional operational benefits to the Districts and network. The Waitlist project has commenced at the Northern NSW and Mid North Coast Local Health Districts in August this year with a planned go live in June 2020. The other Cerner sites are currently planning and scheduling to commence their Waitlist project work in 2020.\

For further inquiries

Dominic Dawson, Acting EBI Program Director, NSW Ministry of Health
Phone: 9391 9072

Surgical Services Taskforce update

In 2019, the Surgical Services Taskforce and Agency for Clinical Innovation (ACI) have focussed on implementation of quality improvement initiatives, and strategies to minimise low value, variable or potentially inappropriate surgical care in NSW.
This has included ongoing support for implementation of the Australian Commission for Safety and Quality in Healthcare’s Hip Fracture Clinical Care Standard at over 30 hospitals in NSW, under the Leading Better Value Care program.

A community of practice for environmental sustainability in operating theatres has provided a platform for districts to share their local initiatives and successful projects, with membership growing to over 130 people throughout the year.

The NSW Collaborative of the National Surgical Quality Improvement Program (NSQIP) continues to expand, with 17 hospitals in NSW now participating and additional hospitals in QLD and Victoria also joining. The Collaborative met three times in 2019 to share how the program is progressing in their hospital and learn from other participants.

Exploring approaches to identify and address low value surgical care has resulted in publication of a number of organisational strategies to minimise potentially inappropriate or low value orthopaedic surgery, with a broader program or work across various surgical specialties planned in 2020.

In November the Surgical Services Taskforce hosted representatives from the American College of Surgeons to review alignment of surgical leadership, care processes and quality programs between health systems. Lessons learned by ACI and the Surgical Services Taskforce can be applied across health services and will assist ACI and SST to work with hospitals wanting to review their surgical services locally, recognise opportunities to improve care processes and patient outcomes and to coordinate multidisciplinary improvement activities across districts.

Further details, including site contacts for the program, are available on the ACI website.

For further inquiries

Crystal Burgess, Manager, Surgical Services Taskforce
Phone: 0410 550 359

Frequently asked questions

A patient brought in a Recommendation for Admission (RFA) for a surgery that we don’t do at our hospital, what should I do?

Do not add the patient to the waitlist.

Section 2.3 of the Waiting Time and Elective Surgery Policy outlines the requirements for the introduction of new procedures and new health technologies.

A doctor may only refer patients for addition to the waitlist for which the doctor has been given privileges by the relevant credentials committee. This approval must happen prior to submitting an RFA.

Decisions made regarding the introduction of new procedures, interventions and new health technologies in NSW should be made taking into consideration available evidence, cost implications and the requirement of the health system to provide contemporary high quality clinical services.

A Local Health District/Network New Interventions Assessment Committee or equivalent must formally approve new procedures.

A RFA for a new procedure/intervention/ technology should not be accepted by the hospital until approval for the procedure has been given. A copy of the decision should be forwarded to the hospital’s admissions manager.

NSW Health has developed a framework for New Health Technologies and Specialised Services.

More information and an example of how to manage this can be found in the Elective Surgery Waitlist Management Resource Guide.

What are the auditing and reporting requirements of the Waiting Time and Elective Surgery Policy?

Frequent monitoring, auditing and reporting is designed to ensure that patients are being correctly managed while on the list for elective surgery, that patients are being treated in turn and the management of the waitlist is a fair, clinically appropriate and transparent process.

Each hospital is required to nominate a person responsible for the clerical audit of the hospital waiting list. This includes conducting audits and reporting the outcome to the relevant manager.

There are both weekly and monthly auditing and reporting requirements which are outlined in Section 6.5, 7.1, 7.2 and 7.3 of the policy.

The Elective Surgery Waitlist Management Resource Guide has information on the reporting requirements. We have provided a list of each reporting requirement that can be downloaded from the NSW Surgery Performance Page. There is a list of reports available split by patient administration system CERNER and iPM as they are the two systems with the highest users across the state.

For further inquiries

Melinda Pascoe, Prinicpal Policy Officer, Surgical Services, NSW Ministry of Health
Phone: 9391 9557

Tell us what you think

The surgery newsletter is published to provide an update for surgery across NSW. We would like to hear from you. Did the content meet your expectations? What would you like to see included next time? Have you got a project that you are working on? Tell us about it and we can feature you in the next edition.

Email the Editor
Melinda Pascoe, Principal Policy Officer, Surgery
Phone: (02) 9391 9557
Email: MOH-SPB@health.nsw.gov.au

Current as at: Friday 29 November 2019
Contact page owner: System Purchasing