REFERRING PATIENTS FOR ELECTIVE SURGERY

2 REFERRING PATIENTS FOR ELECTIVE SURGERY

The referring surgeon must:

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  Complete an approved RFA Form ensuring the minimum data set is complete, legible and accurate
  
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  Assign a clinical priority urgency category consistent with the National Elective Surgery Urgency Category guideline and provide a clinically verifiable reason to assign a different category (if required)
  
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  Ensure patients are fully informed about the risks and benefits of the procedure and have consented to the treatment offered¹
  
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  Consent to be completed by the surgeon performing the surgery or his delegate e.g. Registrar
  
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  If consent is provided by the person prior to their current admission, they are to have their consent reconfirmed on the ward or in the Surgical Admissions Area prior to transfer into the theatre suite. The staff member confirming consent will need to ensure that the person signs the Confirmation of Consent part of the Consent to Treatment form as part of this process
  
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  Ensure patients are ready for surgery and ready to accept a surgery date
  
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  Forward the completed RFA to the Central Wait List Service within 5 working days of signing the RFA
  
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  Ensure the RFA is signed and dated on page 4
  
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  Inform patients that while generally public patients will be admitted under the care of the referring surgeon, this is not guaranteed
  
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  Inform patients that the location of their surgery can vary and they will be allocated a surgery site appropriate to their surgical requirements
  
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  Ensure that they are able to perform the patients surgery within the clinical priority urgency category timeframe that they assign (excepting patients who may require multimodality therapies as part of their treatment plan e.g. some colorectal surgery)
  
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  If a RFA is presented for a procedure(s) a surgeon is unable to perform, for any reason, the RFA is not to be added to the surgeons’ waiting list and should be returned to the doctor’s rooms as soon as possible
  
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  Inform the patient of an approximate waiting time for surgery
  

Categorisation of elective surgery patients is prioritised by clinical urgency and is required to ensure patients receive care in a timely and clinically appropriate manner. A clinical urgency priority is assigned by the referring surgeon using the National Elective Surgery Urgency Categories as a guide. Categories assigned outside the guidelines must have a clinically verifiable reason documented in the section provided on the RFA. RFAs received with a clinical priority urgency category outside of the National Guidelines and no documentation of a clinically verifiable reason will be added to the elective surgery Wait List in accordance with the National Guidelines. The Specialist Surgeon will be notified by letter (Appendix 6) that this has occurred. If a clinically verifiable reason exists for allocation to a higher/lower category, the Specialist Surgeon will be required to submit a re-categorisation form for processing within 7 days stating the clinically verifiable reason for change.

Elective Surgery is categorised into the following 3 categories which are defined as:

Category 1: Procedures that are clinically indicated within 30 days.

Category 2: Procedures that are clinically indicated within 90 days.

Category 3: Procedures that are clinically indicated within 365 days.

2.2 Re-classification of the Clinical priority Urgency Category

Reclassification to a lower category (category 1 to category 2) the patient must be directly informed by the clinician, and reasons given to the patient.

Re-classification cannot occur following a review of clinical notes only, but can occur following receipt of investigative results that indicate a deteriorating, or improving condition.

Re-classification is independent of the outlined processes related to the National Elective Surgery Urgency Category Guideline when a patient is first added to the elective surgery waiting list.

Re-classification must not be used to facilitate ‘on time’ surgery when difficulties in scheduling may arise.

Authority to reclassify a patient’s clinical priority urgency category may only be undertaken by the Consultant or Delegate, who must complete the reclassification of clinical priority form, stating a clinical reason for the change. The clinical reason for the change may reflect deterioration in the patient’s condition or an improvement/reassessment of the patient’s condition. The re-classification will not be processed if a form is not completed or the form is incomplete.

Documentation of a re-classification must be recorded in the patient electronic record (ACTPAS) giving the reason for the change. Patients must be advised of any change in their clinical priority urgency category and a brief summary of the telephone conversation recorded in the patient’s electronic record.

Should the referring surgeon complete a new RFA form assigning a new clinical urgency category, this can only be accepted if the patient has signed the consent form or there is evidence that a clinical review/assessment of the patient has occurred.

If the new RFA has a different principle procedure listed, the original waiting list entry should be removed as ‘procedure no longer required’. The new RFA is then logged onto the elective surgery waiting list with the new procedure listing date being backdated to the original listing date.

If the new RFA has a minor change to the procedure, i.e. the principle procedure remains the same, the wait listing entry should be amended and the new RFA attached to the original RFA.

Documentation of the changes must be recorded in ACTPAS.

The Territory Wide Surgical Services Team will conduct monthly audits of all re-classifications of clinical urgency and maintain records of the audit results for reporting as required to hospital management and to the Surgical Services Taskforce.