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

Judy Lowthian, Andrea Curtis, Bernadette Comitti, Peter Cameron, Martin Keogh, William Johnson, William Tomlinson, Andrew Stripp

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5 Citations (Scopus)


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.
Original languageEnglish
Pages (from-to)448 - 451
Number of pages4
JournalMedical Journal of Australia
Issue number9
Publication statusPublished - 2011

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