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Fergus Davidson, Chair of Perioperative Governance, from Concord Hospital delivered this presentation at the 2012 Elective Surgery Redesign Conference. For more information about our wide range of medical and health events covering a broad range of industry issues, please visit www.healthcareconferences.com.au
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Fergus Davidson
Staff Specialist Anaesthetist
Chair, Perioperative Governance Committee
Concord, NSW
Wait List Management
Improving “On Time Start” Performance
Managing Day of Surgery Cancellations, and Emergency cases
Debra Pickrell, Manager Patient Services and Information Department
Fiona Wallace, SNUM Perioperative Service
Kathy Musson, Perioperative Data Manager
Ellen Villeneuve, NUM Day Surgery and PAC
Prof Peter Haertsch, Head of Department of Surgery
Staff at every level within peri-operative areas
Reliable Data
Regular scrutiny of data
Continuous communication
Clinical and corporate leadership
Maintain focus on the goals
Weekly Meetings.... Central Bookings manager meets with
General Manager
District Director of Clinical Operations
Head of Anaesthetics and SNUM theatre
Regular Data Reports Facility data reports monthly
SLHD dashboard monthly
Patient Administration System reports weekly Updated lists of waiting patients
Lists of patients approaching due date
Reports sent to surgeons weekly Tentative lists
Unallocated wait-listed patients
Structured audits of waiting lists Reconfirmation of those waiting longer than 6 months
Surveillance for those admitted through ED
Follow-up of FTAs
Follow-up of delayed patients
Reports generated daily/weekly/monthly
Processes Staff orientated in all areas, and roles are flexible
RFA triaged on receipt, according to Clinical Priority Category
CPC is immediately in focus
Building of theatre lists 6 weeks to 3 months ahead
Highlighting potentially overdue cases
Wait list report by CPC, highlighting unallocated cases and their due date
PAS programmed to warn staff if attempting to book beyond CPC date
Mostly manual: room for more IT help
NSW Bureau of Health Information BHI
Constantly monitoring
Anticipating several months ahead
Patients needing theatre time
Theatre time needing patients
Auditing of waiting lists
Re-confirmation processes
Follow up FTAs
Communicating with decision makers
Referring to Policy and CPC guidelines
Communication Widespread awareness of goals
Strongly collaborative approach
Building relationships
Funding-related motivation has helped focus on common goals
Off to a Good Start
Off to a Good Start Definitions
Why bother?
Efforts to date
Barriers and plans
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ja
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Ma
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Ju
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Octo
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CRGH Operating Theatres On Time Compliance % Allocated Elective AM Sessions (In OR Time)
2010 to 2012
2012
2011
2010
On time starts On agenda for some years
DPU “Readiness by 0740”
Audited and managed
“In the bay” by 0745
On time starts 0800 Nursing rostering changes
Flexible nursing roles at start of day
Anaesthetic staff formally start 0745hrs
Senior surgeon champion, to chase up stragglers
Better communication about potential delays
On time starts 0800 Files reviewed to anticipate delays to start
First 2 patients admitted 0630hrs
Scrubbed and opening packs well before 0800
On Time Starts
Adjusted On time starts Sept 2012 (69.1%)
Within 10 min of schedule 84%
Within 20 min of schedule 94%
Oct 2012 (69.3%)
Within 10 min of schedule 85%
Within 20 min of schedule 93%
The last 30% Formal project to review residual delays
Education and Awareness
Focus groups
Debates about definitions
“This project is garbage & meaningless”
Accounting for “legitimate” reasons for late entry to theatre
Managing Emergency cases and
Day of Surgery Cancellations
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
2012
2010
2011
CRGH Operating Theatres
Monthly ElectiveCancellations as a % of Booked Elective Procedures
Equipment issue
No bed
Surgeon related
Displaced by Emergency
Pt other
Surg no longer required Preexisting
illness
FTA
Patient refused
List over booked
Acute illness Displaced by case overrun
Other
Day of Surgery Cancellations 2007-2012 n = 2403
Cancellations 2007-8 vs 2011-12 N= 941 N= 644
No bed 26 10
Equipment prob 24 14
Surgeon related 37 10
Displaced by emerg 34 26
Not prepared 38 27
Surg no longer required 18 49
Pt other 18 54
Pre-existing illness 76 28
FTA 74 54
Pt refused 182 37
Overbooked list 113 58
Acute Illness 143 131
Displaced by Overrun 125 133
Equipment issue
No bed Surgeon related
Displaced by Emergency
5
Pt other
Surg no longer required
Preexisting illness
FTA Patient refused
List over booked
Acute illness
Displaced by case overrun
Other
Day of Surgery Cancellations 2011-12 n = 644
Day of Surgery Cancellations Detailed records of each cancelled case
Monthly data review at Periop meetings
Periodic audit of medical record
Day of Surgery Cancellations - Recurrent weaknesses
Anticoagulants
Over-optimistically booked lists
Burns surgery
Country patients
Mis-communication
Poor quality data
Minimising Cancellations RFA revision
Anticoagulant instructions
Theatre instructions
Feedback to surgeons to raise awareness
Better review of long wait and FTA cases
Cleaner data
Non-elective surgery at Concord
Only 25% of cases
Modest impact on DOS cancellations
Not high on our agenda until 2010
Emergency surgery done within benchmarks Target 90%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2010
2011
2012
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
January March May July September
Bankstown
Concord
Liverpool
RPA
Urgent KPIs - Hospital Comparison 2011
Non-elective surgery at Concord Daily emergency list
Morning trauma lists 2-3 /week
Cases generally added to end of elective list unless clinically more urgent
Surgical Super liaises when elective surgery needs to be interrupted
Non-elective surgery at Concord Surgical champion identified: much more involved
Surginet on-line booking
Pro-active management by co-ordination desk staff
Guided more by urgency codes
Improved reliability of urgency coding
Monthly dashboards to focus on performance
Peri-operative Performance at Concord Hospital
Reliable and accessible data, regularly scrutinised
Continuous communication
Clinical and corporate leadership
Maintain focus on the goals