Sustaining change • Incomplete RFA forms and SMS confirmation data
reported monthly at staff and divisional meetings. • Specialty Waitlist Report tabled at HoD meetings. • Patient notification of planned date of admission and
cancellations reported at monthly divisional, HoD and departmental meetings.
• Customised waitlist management strategies to be identified across all surgical specialties.
• Second phase of elective surgical booking redesign to progress with Pre-Admission Clinic Redesign Project.
Conclusion • 100% of surveyed patients post solution implementation
stated that they had a positive experience with the bookings process and services at Westmead Hospital.
• Staff have appreciated the consultative and collaborative approach throughout the project redesign phases.
• There has been a positive effect on workplace culture as demonstrated in the staff and patient evaluations.
Acknowledgements • Sue Henderson, Operations Director, Division of Surgery and
Anaesthetics, Westmead Hospital; Project Sponsor • A/Prof Gary Morgan, Clinical Director, Division of Surgery and
Anaesthetics, Westmead Hospital • A/Prof Andrew Brooks (HoD Urology), Dr Mauro Vicaretti (HoD
Vascular), Dr Lissa Buenaventura (Anaesthetics/PAC), Clinical Leads
• Margaret Wall, Surgical Access and Waitlist Manager, WSLHD • Emma Clarke, Director Service Improvement, WSLHD • Dr Tony Pang (General surgeon), Anne Cresswell, Gloria
Wojtun, Dr Matt Stanowski(Urology fellow), Clementia Yap, Project Team Members
Contact Brian Julien: [email protected] Carmen Hoffmann: [email protected] Phone: (02) 8890 6623
Diagnostics Case for change Patient experience required improvement as demonstrated by: • 900 (19%) of patients are given 1-7 days notice of
their Planned Date of Admission (PDA). • 1600 (50%) of cancellations occur with only 1-7 days
notice prior to their PDA. • 4000 patients PDA is re-scheduled.
(data from May 2014-April 2015)
Goal Achieve a patient focused approach to improve the patient experience by timely communication with patients regarding their PDA.
Objectives • ≥95% of our Clinical Category 2^ and 3# Vascular and
Urology patients will have >7 days notice of their planned procedure date by March 2016 (Vascular 71.5%, Urology 77.1% as at April 2015).
• ≥85% of our Vascular and Urology patients who have their procedure cancelled by the hospital will receive >7 days notice of the cancellation by March 2016.
^procedures clinically indicated within 90 days #procedures clinically indicated within 365 days
Method • Booking and Admissions Tracking (2hrs) • Day-Only Ward Tracking (16hrs) • Recommendation for Admission (RFA) Process
Mapping (4hrs) • Data Analysis (12 month KPIs) • Policy and Guideline Reviews (4hrs) • Patient Interviews (n15) • Patient Journey Mapping (n15) • Staff Interviews and Surveys (n35) • Issues Prioritisation (3hrs)
Improving Surgical Access for Patients Elective Surgical Bookings Redesign Project
Brian Julien & Carmen Hoffmann Project Leads, Division of Surgery and Anaesthetics
426
1601
498 650
DOSC 1-7 8-14 >14
Num
ber o
f Occ
urre
nces
Number of Days prior to allocated Date of Surgery
Cancellations and Rescheduling Timeframe for Westmead Hospital Elective Surgical patients
1 May 2014 - 30 April 2015
Source: iPM TH58
Issue Solution Results Waitlist Policy Compliance - Limited awareness of current specialty and surgeon
specific waitlist KPIs identified in surgeon survey. - Limited awareness of MoH Waitlist Policy.
Generation of monthly Specialty Waitlist Report sent to Head of Department (HoD).
Specialty Waitlist Report evaluation survey shows that: • 100% of HoD state that the report easily
identifies the next treat in turn patients, helping plan elective surgical lists.
• 100% of HoD would recommend this report to other organisations.
Development of local Policy Compliance Procedure document.
Document developed to identify local governance for waitlist management.
900 (19%) Clinical Category 2/3 patients given a surgery date 1-7 days prior to PDA - Under booking of surgical list. - Unable to readily identify suitable patients to fill surgical
vacancy at short notice. - Identified patients on short notice list were not clinically
suitable. - From 15 surgical specialties, only Urology and ENT
theatre lists are facilitated by Admissions and Bookings.
RFA forms stamped with “Short Notice List” tick box.
13.5% of stamped forms returned have been completed post implementation.
Admissions and Bookings facilitated theatre list.
August 2015 to March 2016 average percentage of Clinical Category 2/3 patients given a surgery date >7 days prior to PDA: • Urology: ↑92.5% (from 77.1%) • Vascular: ↓64.0% (from 71.5%)
Incomplete RFA forms - Approx. 30 RFA forms per month submitted to bookings
office with missing mandatory minimum data set. - Time wastage of admissions and bookings staff following
up missing mandatory minimum data set.
Incomplete RFA for Clinical Category 2/3 patients not accepted.
Returned Cat 2/3 RFAs/month July 2015 to March 2016
Month Jul Aug Sep Oct Nov Dec Jan Feb Mar
Tally 24 5 3 3 5 8 1 4 7
Averaging 4.5 returns/month since August implementation
1600 (50%) Cancellation and Rescheduling of patients occur 1-7 days prior to PDA - Patient not available, no longer requiring surgery or
treated elsewhere.
SMS reminder/confirmation sent to patients 10 days prior to their PDA.
Implemented since December 2015: • Average responses: 54% (n691). • Approximately 55 less incoming phone calls
to bookings and admissions office per week. • 100% of patients surveyed satisfied with SMS
service.
= Bottleneck in the process
This has been a great cultural change for this hospital. We have empowered the surgeons to be more responsible with the surgery that they perform at Westmead.
All the staff have been amazing! The SMS fantastic; it reminded me about my surgery, plus I live in the country, so I didn’t have to spend a lot of money on a phone call.
We’ve become more efficient; it feels a lot calmer around here, and we do a lot less chasing up. We can concentrate on getting it right for our patients!
0%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Perc
enta
ge
Vascular and Urology Elective theatre bookings 2015-2016 >7 Days PDA notice given to Category 2/3 patients
UrologyVascularTarget (95%)
Lessons Learned during Implementation Phase: Specialties with higher urgent procedures (Emergency and Cat 1) patients are difficult to apply the elective surgery waitlist management solutions to, due to theatre access and scheduling, as evident with the Vascular specialty.