June 2017 Surgery Newsletter

In this edition

1. Message from the Executive Director
2. Meet the Team at Lithgow Hospital
3. Waiting TIme and Elective Surgery Policy Education
4. Support for Nurses and Midwives is only a phone call or click away
5. Cerner Wait List Optimisation Project
6. Learn how to improve the success rate of your surgery projects
7. Totally Hip (and Knee) - Tweed Hospital
8. My Check-in for Surgery - Canterbury Hospital
9. Information Bulletin: Indicator Procedure Code Update
10. Tell us what you think

Message from the Executive Director, System Purchasing Branch

Hi everyone and welcome to the June 2017 Edition of the Surgery Newsletter.

This edition has a strong focus on the value of team work. Melinda Pascoe and Chrissie Crawford from the Ministry have been out to visit many of you over the last quarter and have not only come back to report on the fantastic work but the way teams are treating each other with respect and modelling the CORE values.

The last few months have been an extremely busy period for NSW Health. Despite increases in volume and the challenges of winter, the percentage of patients who have their surgery completed within their clinically recommended timeframe has increased.

The May Elective Surgery Access Performance (ESAP) Year to Date results are:

• Category 1: 99.8% (99.8% last year)
• Category 2: 97.6% (97.1% last year)
• Category 3: 96.5% (95.6% last year)

The total number of overdue elective surgery patients at the end of May 2017 was 7% less than it was in May 2016.

The most recent Bureau of Health Information Quarterly Report (January to March 2017) highlights included:

• 97.1 per cent of all elective surgery patients underwent their surgical procedure within the clinically recommended timeframe. This is a 0.1 percentage point improvement compared with the same quarter last year.
• Median wait time improved or remained stable across all three clinical priority categories, in particular the non-urgent median wait time reduced by eight days.
• There was a 5.6 per cent increase in elective surgery procedures performed (total number 51,830) in January to March 2017, compared to the same quarter last year.
• Elective surgery median wait times (compared with the same quarter last year) for:
• Cataract extraction – reduced by 23 days to 230 days
• Total knee replacement - reduced by 10 days to 291 days
• Total hip replacement - increased by 3 days to 221 days

Note: These median wait times are all within the clinically recommended timeframe of 365 days.

These improvements are an outstanding achievement and a credit to the ongoing hard work and dedication of the many staff in the Districts and Networks. The ongoing efforts are well recognised by the Ministry.

Congratulations! Working hard together as a team with one vision truly wins in the end. Excellent work guys! Your hard work has truly paid off.

Elizabeth Wood

Executive Director, System Purchasing

Meet the team at Lithgow Hospital

On 8 May 2017, the surgery team at Lithgow Hospital enjoyed a development day consisting of education sessions, team bonding activities and time to celebrate their success together.

The team at Lithgow was awarded first place by the Nepean Blue Mountains Local Health District for their project ‘Teamwork achieves amazing things’ - they improved on start times and even raised over $60,000 to help a fellow staff member in need! The team has met targets for elective surgery access performance and ensured all patients are treated within clinically recommended timeframes.

They were also highly commended for a range of other projects:

Reducing Perioperative Hypothermia in Lithgow which focused on why patients get hypothermia and prevention strategies

Streamlining processes in Lithgow Day Surgery Unit which looked at improving efficiencies and reducing DOS cancellations.

Melinda Pascoe and Chrissie Crawford were fortunate enough to be invited along to the day to deliver training and provide a state-wide surgery update. Your sincere efforts and hard work is indeed highly appreciated. You should be proud of yourselves. Congratulations to all! Keep up the good work.

Waiting time and elective surgery policy education

In April 2017, Melinda Pascoe, Principal Policy Officer visited Wollongong Hospital to conduct training on the Waiting Time and Elective Surgery Policy for the Illawarra Shoalhaven Local Health District Surgery Team. Topics covered included:

• acceptance of the Recommendation For Admission
• variations from standard bookings
• registration on the waiting list
• ready for Care
• managing Not Ready for Care
• record Keeping
• what constitutes a genuine offer
• testing knowledge scenarios and more.

If you would like some training in your Local Health District or Specialty Health Network on the above topics please contact Melinda Pascoe on (02) 9391 9557 or via email at mpasc@doh.health.nsw.gov.au

Frequently asked questions

How long can a patient defer their admission if they are unable to accept a date for their treatment e.g. if they are going away on Holidays?

The patient’s current clinical priority category will determine the maximum days (cumulative) a patient can defer treatment:

• CPC 1 (admission within 30 days) = 15 days
• CPC 2 (admission within 90 days) = 45 days
• CPC 3 (admission within 365 days) = 180 days

The hospital/patient should confirm with the treating doctor if it is clinically appropriate for the surgery to be deferred for Category 1 (admission within 30 days) patients.

The hospital must record the reason for the deferral on the electronic waiting list and on the patient’s RFA.

Can a treating doctor add patients to their waiting list whilst they are on Leave from the hospital, for example due to either sick or annual leave?

No. During the leave period, no further patients should be added to the doctor’s waiting list unless approved by the District/Network Program Director of Surgery (Waiting Time and Elective Surgery Policy PD2012_012 - Section 8.Doctor’s Leave - Temporary and Permanent).

Support for nurses and midwives is only a phone call or a click away, no matter where you are in Australia

We understand that nurses, midwives and students can have health issues that could affect their capacity to work.

When you need support the Nurse & Midwife Support will provide confidential advice, assistance and referral. It is the first national telephone and online service of its kind in Australia.

To find out more about this service, please refer Nurse and Midwife support document.

Cerner Wait List Optimisation Project

Phase 1

Functionality optimisation is at the final stages.

Phase 2

EDWARD extract is underway with testing due to commence during the 1st week of July.

In order to meet Cerner Corporation’s deadline for the next Worldwide General Release in February 2018, the project is working towards having the Phase 1 and Phase 2 changes deployed into Production within SYS/SWS by early October. Meeting this deadline will allow for this functionality to be made available for roll-out to other Cerner PAS LHDs from February 2018.

An education session has been arranged for the afternoon of Thursday 6 July 2017. The Cerner Wait List Optimisation Project (CWLOP) team will be providing a demonstration of the new Wait List functionality proposed for Cerner.

The venue for the day will be Conference room 2, Level 5, NSW MoH, 73 Miller Street, North Sydney. For those unable to physically attend, the education session will be held via WebEx.

All those wishing to attend are required to RSVP to John Hallett by close of business Friday 30 June 2017 via email johal@doh.health.nsw.gov.au

Learn how to improve the success rate of your surgery projects

Accelerating Implementation Methodology (AIM) is a practical guide to effectively managing change by overcoming personal and cultural barriers. AIM is about learning how to address or remove obstacles that might prevent you from delivering projects on time, on budget and within scope.

The Surgery AIM course focuses on surgery-specific projects and is aimed at any staff member who is involved in, or who would like to be involved in, change management initiatives.

Who should apply?

Change Leaders, Project Managers, Training Managers and clinical/non-clinical staff.

What are some examples of relevant surgery projects?

Operating theatre efficiency, emergency surgery redesign and hip fracture management.

The next Surgery AIM course will run on Tuesday 19th and Wednesday 20th September 2017 in Chatswood.

Apply to the Accelerating Implementation Methodology course

The deadline for applications is Friday 28 July 2017.

For questions about the course and/or the application process, please contact:

Gavin Meredith
02 9464 4644
gavin.meredith@health.nsw.gov.au

Sarah- Jane Waller
02 9464 4728
sarahjane.waller@health.nsw.gov.au

Totally hip (and Knee)

The Tweed Hospital

This project reviewed the journey of patients undergoing an elective total hip or knee replacement at the Tweed Hospital. The Project Team, in consultation with staff and patients, implemented a range of improvements, including preoperative assessments, patient information brochures, clinical pathways and pain management.

Aim

To reduce the Length of Stay (LoS) for patients undergoing elective hip and knee replacement, and better prepare patients to manage at home following discharge.

Benefits

• enhances collaboration between nursing, medical and allied health clinicians
• improves clinical pathways and protocols for medication and pain management
• streamlines the preoperative and post-operative patient journey
• better prepares patients for managing at home following discharge from hospital
• increases bed capacity in the hospital, allowing more patients to be treated
• decreases LoS and associated costs for the organisation
• reduces the number of patients presenting to the emergency department (ED) within 21 days of discharge.

Background

Reducing clinical variation is a key priority for Northern NSW Local Health District (NNSWLHD). A review of NSW health data for the 2014-15 financial year identified that average LoS and costs were higher for elective hip and knee replacements at the Tweed Hospital, compared to peer hospitals. This group of patients stayed in hospital a total of 110 days longer than peer hospitals and cost the organisation an additional $135,000. Further data analysis identified that 10% of patients were returning to the ED within 21 days of surgery and 60% patients did not know what to expect following discharge from their hip or knee replacement surgery.

Implementation solution

Following extensive consultation with staff and patients, the following four solutions were identified.

Solution 1: Preadmission clinic

• A database was developed to track patients on their journey through the Preadmission Clinics, so all staff contributing to preoperative assessments could monitor their progress.
• The Allied Health Preadmission Clinic was expanded to allow individual assessments by both physiotherapists and occupational therapists, with a focus on preparing the patient for discharge.
• Patient information booklets have been developed and are currently with consumers for feedback. These will be provided to the patient before they attend the Preadmission Clinics, to help them understand their journey through hospital and discharge instructions

Solution 2: Multidisciplinary approach

• Multidisciplinary meetings are held three days per week, comprising nursing, medical, physiotherapy, occupational therapy, pharmacy and social work staff.
• Following the meeting, the care plan is recorded directly into the patient’s electronic medical record.
• Clinical pathways were updated to reflect current best practice and expanded to include allied health disciplines.
• The expected date of discharge is displayed above the patient’s bed and reviewed by the ward physiotherapist, to help the patient prepare for discharge.

Solution 3: Medication management

• Junior Medical Officers (JMOs) and pharmacists meet with patients on admission to discuss and order the patient’s usual medication before surgery.
• A ‘red flag’ medication list was developed to highlight which medications require consultation with registrars prior to ordering.
• An aperient medication protocol was established, to guide JMOs in the management and prevention of post-operative constipation.

Solution 4: Pain management

• A pain management options paper was developed following a literature review, to provide general recommendations for JMOs on discharge pain management, as well as advice on what to include in the discharge summary for general practitioners.
• A discharge pain management brochure has been developed for patients and is currently with consumers for feedback

Evaluation

• A full 2016/17 LOS review will commence in August 2017.
• The following results were achieved between July 2016 and February 2017:
• average LoS for total hip replacements was reduced from 4.9 days to 3.9 days
• average LoS for total knee replacements was reduced from 5.3 days to 4.0 days
• ED presentations within 21 days of surgery was reduced from 11.7% to7.4%
• attendance at the Allied Health Preadmission Clinic increased from 35% to 90%
• 86% of patients had their usual medications written up preoperatively
• 87% of patients had a preoperative pharmacy review
• 86% of patients surveyed (n=29) reported they were given enough information to manage at home (previously 40%)
• 100% of patients felt that staff did everything they could to help manage their pain

Lessons learnt

• The Centre for HealthCare Redesign framework is robust and provides a great structure to ensure timelines are met.
• Having the support of a key medical champion is imperative.
• The development of protocols and documents is very resource intensive and takes longer than anyone expects.
• Make friends early with executive assistants and receptionists – they will be your strongest allies.

Contact

Lynn Hopkinson
Manager Service Redesign
The Tweed Hospital
Northern NSW Local Health District
Phone: 02 66200843
lynn.hopkinson@ncahs.health.nsw.gov.au

My Check-in For Surgery - Canterbury Hospital Pre-admission Clinical Redesign Project

This project has focused on improving the elective patient preoperative journey as well as clinician satisfaction and hospital efficiency.

Project goal

To provide a high quality, streamlined and sustainable patient centred approach to booked adult surgical services at Canterbury Hospital from the completion of the Recommendation for Admission (RFA) until the day of surgery.

Objectives

• to improve the patient experience of care in the Pre-admission Clinic
• reduce the overall average patient wait time in the anaesthetic Pre-admission Clinic
• to reduce the number of lower risk patients required to attend a full Pre-admission Clinic
• to reduce the number of elective surgery, patient-related day of surgery operating theatre cancellations to less than 2%.

Method

My Check in For Surgery has involved a robust, six stage project methodology using process redesign and change management principles to improve health care and patient journeys. Wide consultation with staff, patients and community stakeholders has assisted to identify barriers and areas for improvement.

Six key issues were identified -communication, clinical processes, guidelines and policy, waiting time, health literacy and data collection. To address these, eleven solutions were developed.

Solution implementation

Implementation required a phased approach due to solution interdependencies as well as to reduce change fatigue and manage workload. Solutions included:

• Improved communication with GPs, obtaining input early in the patient journey and communicating with the GP after patient assessment in clinic. A pre-operative Health Pathway is being developed by SLHD Health Pathways in collaboration with project team representatives.
• Improved communication between the Admissions Office, Pre-admission Clinic and Day Surgery Unit and development of tools to support new processes.
• Improved patient health literacy resources, with implementation of a variety of clinician developed and consumer reviewed information brochures.
• Redefinition of roles within the Pre-admission Clinic to improve efficiency and reduce duplication. Establishment of a PAC screening/triage role and review of JMO role were key achievements.
• Revised risk screening tools and defined escalation processes to improve outcomes for patients and clinician satisfaction.
• Resource requirements have been provided and included in Canterbury Hospital Clinical Services Plan.
• Pre-operative testing guidelines for surgeries have been developed and endorsed in consultation with surgeons and anaesthetists.
• Role accountability for follow-up of identified patient risks has been clarified and tools to support processes developed.
• Clinic booking times have been revised within limitations of current restrictions of space and capacity. Scheduling processes are being streamlined.
• Identification of need for interpreters and patient booking processes have been improved to align interpreter availability with requirement.
• Improved data collection in Pre admission Clinic to assist with monitoring of improvements.

Implementation of these solutions has only been possible due to sustained collaboration and support from staff who have been engaged and committed to improving systems and the patient’s journey.

Some results to date

• Average patient wait times in clinic have reduced from three hours in April 2016 to 2.3hours in May 2017.
• May 2017, new clinic triage guidelines were introduced which focus on maintaining safe practices and improving efficiency by reducing unnecessary attendances at clinic for low risk patients. Patient attendances at clinic will continue to be monitored.
• Patient related day of surgery cancellations have decreased overall from 3.28% (monthly average 2015), to less than 2.5% September 16 – March 17 with ongoing monitoring to identify areas for improvement.

Other key achievements include:

• Decreased patient non- attendance at clinic from 15% in June 2016 to 6% in April 2017.
• Improved data collection with over 90% patients electronically checked out of PAC since May 2016.
• Monthly patient feedback surveys reflect improved patient satisfaction.
• Post implementation staff satisfaction surveys are currently being repeated with current results indicating staff are more satisfied with processes and identifying improved efficiency.

Next Steps and sustaining improvements

• Embedding key monitoring and reporting processes into established committees for ongoing review.
• Revision of the Canterbury Hospital RFA.
• Completion of EMR and clinic booking scheduling improvements.
• Multicultural versions of new patient communication documents.
• Completion of SLHD Pre-operative Health Pathway.

Conclusion

Involvement of key clinicians and stakeholders, strong project team leadership and sponsor support has allowed the success of this project.

Implementation of eleven solutions to address key issues has been achieved through the commitment of solution owners and clinical leads working together and reporting to a Steering Committee.

Ongoing monitoring processes are being established, embedded in everyday business to ensure sustained change and continuous identification of areas for further improvement or refinements to further improve KPIs.

Acknowledgements

Canterbury Hospital Patients and Carers, Ambulatory Care and Pre-admission Staff, Admissions Office and Day Surgery Staff, Anaesthetists, Surgeons, local GPs, SLHD Health Pathways Representatives, Steering Committee Members, Hospital Executive, Project Team and Sponsors, ACI representatives and SLHD Clinical Redesign Representatives.

Contact

Judy McGlynn, Complex Care CNC, Canterbury Hospital
judy.mcglynn@sswahs.nsw.gov.au or (02) 9787 0254

Information Bulletin IB2017_009: Indicator Procedure Code Update- Effective 1 July 2017

Purpose

The purpose of the Information Bulletin is to inform NSW Health service providers and source system administrators of changes to the Indicator Procedure Code (IPC) classification for use in the Elective Surgery Waiting Times Data Collection.

Elective surgery wait list implementation advice

The NSW Ministry of Health expects that all patients that are on the elective surgery waiting list as at 1 July 2017 will be re-coded / re-aliased to the appropriate retained IPC.

Any necessary IPC re-coding / re-aliasing must be undertaken prior to 1 July 2017, particularly for those Wait List bookings that have no Planned Admission Date (PAD) or have a PAD post 30 June 2017.

Wait List removals for June 2017 may still be reported with a retiring IPC, as retirement will take effect from 1 July 2017.

If a patient administration system (PAS) is using internal IPC values which are outbound aliased, then any affected internal codes will need to be re-aliased.

Patients added to the elective surgery waiting list from 1 July 2017 must not be assigned an IPC that had been retired.

Tell us what you think

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 Pascoe
Phone: (02) 9391 9557
mpasc@doh.health.nsw.gov.au

Ms Chrissie Crawford
Phone: (02) 9391 9394
ccraw@doh.health.nsw.gov.au