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Purpose of self-assessment:
The Elective Surgery Access Policy was developed to promote clinically appropriate, consistent and equitable management of elective surgery patients and waiting lists in public hospitals across ϳԹ.
The aim of completing the self-assessment is to highlight the areas of the policy that are being met and the areas where there is need for development and improvement.
Step 1: Review process against policy requirements
Policy Ref.RequirementFully CompliantPartially CompliantNon
CompliantSection 2 of policy Summary of key responsibilities 2.1Admissions and booking officer staff add the RFA to the elective surgery list within 3 days of receipt2.2Elective Surgery list managers conduct regular audits of the elective surgery list 2.4Treating doctors inform public patients that their surgery may be conducted by another surgeon/hospital 2.4Treating doctors review their lists at a minimum monthly2.4Treating doctors must ensure their have the capacity to perform a procedures within their CUC timeframe, or make arrangements for another clinician to perform the procedure within the timeframe2.5 Hospital clinical directors of surgical services must ensure there is a process in place to manage allocation of CUC outside of the HYPERLINK "/Performance/Pages/surgeryresources.aspx" \l ":~:text=Elective%20surgery%20resources%20The%20Resource%20Guide%20provides%20practical,surgery%20and%20waitlist%20managers%20to%20administer%20the%20policy." ϳԹ Recommended CUC list. 2.5Hospital clinical directors of surgical services must ensure there is a process for the management of cosmetic and discretionary procedures 2.6 The District/Network program directors of surgical services or equivalent must ensure that there are clear admin and clinical procedures and protocols in place to support the implementation of this policy.
Policy Ref.RequirementFully CompliantPartially CompliantNon
CompliantSection 3 of policy Elective Surgery List 3.1Every RFA added the Elective Surgery list contains at least the minimum data set. 3.2All patients have a clinical urgency category assigned by the treating doctor in line with the HYPERLINK "/Performance/Pages/surgeryresources.aspx" \l ":~:text=Elective%20surgery%20resources%20The%20Resource%20Guide%20provides%20practical,surgery%20and%20waitlist%20managers%20to%20administer%20the%20policy." ϳԹ Recommended Clinical Urgency Categories list OR is accompanied by supporting evidence for the patient to be another category.3.2If there is a departure from the recommended CUC and no supporting evidence is supplied, the treating doctor is contacted to provide the additional supporting information.3.2Each facility (either at hospital or LHD/SHN level) has a process to review and escalate variations from the recommended CUC. 3.2.1Category 1 is only used for patients whose clinical condition has been assessed as requiring the procedure or treatment within 30 days.3.2.2Only treating doctors or their delegate may undertake the reclassification of patients between categories.3.2.2Documentation of reclassification of patients is added to the patients RFA and become part of the patients medical record.3.2.2 The treating doctor is advised about any reclassification change (template letters are available on the HYPERLINK "/Performance/Pages/surgeryresources.aspx" \l ":~:text=Elective%20surgery%20resources%20The%20Resource%20Guide%20provides%20practical,surgery%20and%20waitlist%20managers%20to%20administer%20the%20policy." Elective Surgery Resources page).3.2.3Patients who are booked for a Colonoscopy is allocated a category in line with the ϳԹ Colonoscopy HYPERLINK "https://aci.health.nsw.gov.au/__data/assets/pdf_file/0007/571597/ACI-Gastro-Colonoscopy-Categorisation-Clinical-Practice-Guide-1.pdf" Categorisation Clinical Practice Guide 3.3Each facility (either at hospital or LHD/SHN level) has a process to review RFAs for procedures that are listed under Cosmetic/Discretionary surgery in the policy 3.3Evidence of the review and approval of a cosmetic or discretionary procedure being added to the Elective Surgery List is added to the Elective Surgery List. 3.3 Patients are advised by the treating doctor that their RFA form is going through the approval process3.5Each facility (either at hospital or LHD/SHN level) has a process to formally approve new procedures not previously undertaken at tis I he hospital 3.6An RFA form for a procedure that is not offered by the hospital is returned to the treating doctor3.7Each patient is fully informed about the risks and benefits of a proposed procedure in line with ϳԹ Health HYPERLINK "/policies/manuals/Pages/consent-manual.aspx" Consent to Medical and Healthcare Treatment Manual 3.7Where clinically suitable, public patients are moved to doctors with shorter waiting lists
Policy Ref.RequirementFully CompliantPartially CompliantNon
CompliantSection 4 of policy Acceptance of Recommendation for Admission Form (RFA) 4.1All RFAs received by the booking office are either physically or digitally date stamped4.1Each facility (either at hospital or LHD/SHN level) has a process for the management of RFAs received that do not contain the minimum data as detailed in section 3.14.1RFAs are returned to the treating doctor if treatment is required beyond 12 months4.1Each facility (either at hospital or LHD/SHN level) has a process for the management of RFAs that are submitted to the booking office after 3 months from Dr signature. 4.2.1An RFA must only be accepted for one procedure unless the bilateral procedure is occurring in the same admission or the procedures are independent to each other (for example RFA for a tonsillectomy and a RFA for a Cholecystectomy).4.2.3Each facility (either at hospital or LHD/SHN level) has a process for the checking of duplicate bookings
Policy Ref.RequirementFully CompliantPartially CompliantNon
CompliantSection 5 of policy Notification 5The date stamp on the RFA is used as the listing date for the patient 5.1Patients are advised of their addition to the Elective Surgery list and their CUC within 3 working days of being added to the list (template letters are available on the HYPERLINK "/Performance/Pages/surgeryresources.aspx" \l ":~:text=Elective%20surgery%20resources%20The%20Resource%20Guide%20provides%20practical,surgery%20and%20waitlist%20managers%20to%20administer%20the%20policy." Elective Surgery Resources page).5.2GPs are advised of their patients addition to the Elective Surgery list and their CUC within 3 working days of being added to the list (template letters are available on the HYPERLINK "/Performance/Pages/surgeryresources.aspx" \l ":~:text=Elective%20surgery%20resources%20The%20Resource%20Guide%20provides%20practical,surgery%20and%20waitlist%20managers%20to%20administer%20the%20policy." Elective Surgery Resources page).
Policy Ref.RequirementFully CompliantPartially CompliantNon
CompliantSection 6 of policy Managing patients 6.2All medical and elective surgical procedures that are performed within operating theatres,
procedure rooms and endoscopy suites must be added to the elective surgery list regardless of admission type.6.3.1Patients that are delayed due to hospital reasons are offered a new date within 5 days of being delayed 6.3.2Patents that decline 2 offers with an alternative surgeon are informed they can be removed from the list following consultation with the treating doctor.6.4Patients that will be Staged NRFC are added to the WL and then the Staged suspension period is added 6.4Patients that are Deferring care for personal reasons and are a Category 1 are discussed with the treating doctor prior to being suspended in category/made NRFC6.4If a patient is unavailable on more than 2 occasions they are informed they can be removed from the WL.6.4Patients are not suspended/NRFC for more than the Maximum cumulative days as per table in 6.4 (Staged patients excepted).6.5Each patient suspended/made NRFC has a Status review date. 6.5.1Status review report are generated at least weekly so patients status on the waitlist can be reviewed for example made RFC or schedule a planned admission date6.6Patient scheduled for a clinical review remain RFC6.7 Changes to a patient booking are documented on the RFA and electronic patient record. 6.8.1Category 1 patients are allocated a planned admission date on patient registration 6.8.2All RFAs are reviewed for the need for a preadmission appointment6.8.3Patients are given the option to be a short notice patient in the event of late cancellations 6.9Patients that are postponed due to hospital reasons have the decision noted on their RFA/electronic patient record6.9If a patient has been delayed twice and cannot be treated within the appropriate timeframe, this is escalated to senior management (see also 6.11)6.11Demand management strategies to treat patients on time are used and reviewed for impact regularly by the booking office and senior management 6.12Patients removed from the surgery list for reason other than admission follow the processes described in 6.12. Local processes are documented and signed off by the Theatre committee.
Policy Ref.RequirementFully CompliantPartially CompliantNon
CompliantSection 7 of policy Record keeping and reporting7Admissions/booking office staff must generate and review a weekly report to identify overdue patients (see section 8.1.1).7Monthly reports are generated for the hospital general manager or their delegate with the following information:
Patients who incurred a delay during the month (previous month)
Patients on the list who have had two or more delays to their admission
c. All delayed patients who have not had a rescheduled planned admission date allocated within five days
Policy Ref.RequirementFully CompliantPartially CompliantNon
CompliantSection 8 of policy Auditing the elective surgery list 8.1.1Clerical audits are conducted weekly as per 8.1.1 of the policy8.1.3A process is in place to audit compliance for the district8.3Patients who have been on the list 6 months or more must be contacted to confirm they still require their surgery and confirm any changes in detail.
Policy Ref.RequirementFully CompliantPartially CompliantNon
CompliantSection 9 of policy Doctors Leave 9.1Treating doctors provide at 6 weeks notice of leave for study/annua/parental and extended leave 9.1When a Treating doctor is on leave patients are NOT added to the treating doctors waitlist without approval of the Program Director Surgical Services 9.1An Executive level process is in place to address when Treating doctors resign 9.2Patients are informed and kept updated of progress when a doctor is on extended leave/resigned. Copies of template letters are available at:
HYPERLINK "/Performance/Pages/surgeryresources.aspx" Elective surgery program resources - Performance (nsw.gov.au)
Definitions
Fully compliantPartially compliantNon-compliantProcesses and procedures are in place and are well adhered to
The staff involved with managing the elective surgery list are aware of the requirements of the policy
The team collaborates to ensure patients requiring elective surgery have equitable access in a clinically appropriate timeframe Processes and procedures have been created
Processes and procedures are not always adhered to
There is opportunity for improvement and developmentProcesses and procedures are not in place or not adhered to
Staff involved in managing the elective surgery lists are not aware of their requirements
Resources to assist
HYPERLINK "/Performance/Pages/surgeryresources.aspx" \l ":~:text=Elective%20surgery%20resources%20The%20Resource%20Guide%20provides%20practical,surgery%20and%20waitlist%20managers%20to%20administer%20the%20policy." Elective Surgery Resources Page
HYPERLINK "https://aci.health.nsw.gov.au/__data/assets/pdf_file/0004/252436/operating-theatre-efficiency-guidelines.pdf" Agency for Clinical Innovation, Operating Theatre Efficiency Guidelines
HYPERLINK "http://internal.health.nsw.gov.au/data/edw/edward-training.html" EDWARD training
EDWARD (local and State contacts) - HYPERLINK "http://internal.health.nsw.gov.au/data/edw/edward-contacts.html" http://internal.health.nsw.gov.au/data/edw/edward-contacts.html
Ask a question at the next monthly Elective Surgery Managers meeting
Contact the Elective Surgery Team HYPERLINK "mailto:MOH-SPB@health.nsw.gov.au" MOH-SPB@health.nsw.gov.au
Step 2: Identify and Prioritise areas for improvement
Look at non and partially compliant; are there areas which are within your power to change?
Select t h e a r e a s t h a t r e q u i r e i m p r o v e m e n t t o m e e t t h e p o l i c y f r o m y o u r c o m p l e t e d c h e c k l i s t
&
S e c t i o n 2 S u m m a r y o f k e y r e s p o n s i b i l i t i e s &
S e c t i o n 5 - N o t i f i c a t i o n &
S e c t i o n 8 A u d i t i n g t h e e l e c t i v e s u r g e r y l i s t &
S e c t i o n 3 E l e c t i v e S u r g e r y L i s t &
S e c t i o n 6 M a n a g i n g p a t i e n t s &
S e c t i o n 9 D o c t o r s L e a v e &
S e c t i o n 4 - A c c e p t a n c e o f R F A &
S e c t i o n 7 R e c o r d k e e p i n g a n d r e p o r t i n g
D i s c u s s t h e s e f i n d i n g s w i t h y o u r T h e a t r e C o m m i t t e e , M a n a g e r o r E x e c u t i v e t e a m .
C o n s i d e r t h e f o l l o w i n g q u e s t i o n s t o f r a m e your conversation
Who is affected by the changes required to meet the requirement in the policy?
What is the benefit for the people who will be impacted by the change? for example does the change reduce the time to add a patient to the list for booking office staff or mean a treating doctor has greater visibility of their waitlist?
What changes in behaviour will be needed by those affected?
What can you do to support the change (for example giving people time, education, and opportunity to feedback on the change).
If you have identified an area out of your direct control; who does have control? Can you escalate to your manager to support the change and the communications around the change?
Once you have discussed the findings from your self-assessment, consider your responses in response to the matric below.
What areas of change are high value, low cost and low risk to the organisation if you implemented this change in practice?
Step 3: Identify top 3 areas for improvement
Based on your findings, discussion and use of the matric, identify your areas for improvement below.
Identified areas for improvement
1.
2.
3.
Step 4. Identify action, owner, and timeframe for action to take place
Action OwnerTimeframe Example: Conduct time and motion study to identify barriers to adding RFA to WL within 3 days. WL Manager and Redesign Lead2 weeks.
Elective Surgery self-assessment:
Elective Surgery Access Policy
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image/jpeg
ϳԹ Gov - Health Col
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proof:pdf
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proof:pdf
saved
xmp.iid:f2b98bad-4184-b644-903a-f021704b0bf9
2017-08-08T11:02:34+10:00
Adobe Illustrator CC 2017 (Windows)
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2017-08-08T11:48:42+10:00
Adobe Illustrator CC 2017 (Windows)
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Adobe PDF library 15.00
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