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Streamlining elective surgery care in a public hospital: the Alfred experience
Author(s) -
Lowthian Judy A,
Curtis Andrea J,
Comitti Bernadette L,
Cameron Peter A,
Keogh Martin J,
Johnson William R,
Tomlinson James,
Stripp Andrew M
Publication year - 2011
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2011.tb03057.x
Subject(s) - elective surgery , medicine , perioperative , referral , general surgery , waiting list , surgery , emergency medicine , nursing , transplantation
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.