Streamlining elective surgery care in a public hospital: the Alfred experience

Med J Aust. 2011 May 2;194(9):448-51. doi: 10.5694/j.1326-5377.2011.tb03057.x.

Abstract

Objective: To evaluate the effectiveness of redesigning and streamlining perioperative services.

Design: A before-and-after evaluation, with retrospective analysis of de-identified administrative data.

Setting: A major tertiary hospital, Melbourne, Australia.

Participants: Patients undergoing elective surgery, February 2005 - February 2010.

Intervention: Implementing a process redesign to streamline clinical pathways for elective surgery, with a focus on the patient journey from referral to discharge, and establishing a separate, dedicated elective surgery facility.

Main outcome measures: Numbers of patients waiting beyond national recommended waiting times for elective surgery; hospital-initiated postponement (HIP) rates for elective surgery; and lengths of stay (LOS), both combined and for specific diagnostic-related groups.

Results: The clinical process redesign resulted in a sustained downward trend in the number of elective surgery patients waiting longer than national recommended maximum waiting times. HIP rates were reduced to 1% in the dedicated elective surgery facility, and there was a significant reduction in the combined LOS, as well as the LOS for the most common surgical procedures (P < 0.001).

Conclusions: Clinical process redesign of perioperative services and collocation of a separate elective surgery centre improved (i) timeliness of care for elective surgery patients and (ii) key indicators (LOS and HIP rates) for planned elective admissions.

MeSH terms

  • Elective Surgical Procedures / statistics & numerical data*
  • Health Services Accessibility / statistics & numerical data*
  • Health Services Needs and Demand
  • Hospitals, Public / organization & administration*
  • Humans
  • Length of Stay / statistics & numerical data
  • Patient Admission / statistics & numerical data*
  • Perioperative Care / statistics & numerical data*
  • Quality Improvement / organization & administration
  • Retrospective Studies
  • Surgery Department, Hospital / organization & administration
  • Time Factors
  • Treatment Outcome
  • Victoria / epidemiology
  • Waiting Lists*