Managing Elective Surgery patients in act public hospitals contents
Managing Elective Surgery patients in ACT public hospitals
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- Emergency surgery
- Elective Surgery
- RESPONSIBILITIES Responsibilities of the Patient
- Responsibilities of the General Practitioner (GP)
- Responsibilities of the Surgeon or delegate (Registrar)
- Responsibilities of the Central Wait List Office
- Responsibilities of the Surgical Booking Office
- Responsibilities of the Clinical Director of Surgical Services (TCH) / Director of Medical Services (CHC)
- Responsibilities of the Director of Territory Wide Surgical Services
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Managing Elective Surgery patients in ACT public hospitals CONTENTS 1 INTRODUCTION 4 2 REFERRING PATIENTS FOR ELECTIVE SURGERY 11 2.2 Re-classification of the Clinical priority Urgency Category 12 2.3 Excluded Procedures (Cosmetic and Discretionary) 13 Phimosis, paraphimosis, balanitis, Frenulum breve 14 Only referred from the Obesity Management Service 15 CEAP Grade >2 15 New Procedures 16 The Health Technologies Assessment Committee must formally approve new procedures not previously undertaken. Clinicians must also be appropriately accredited to undertake the procedure before patients are added to the elective surgery waiting list. A doctor may only refer patients for addition to the elective surgery waiting list for procedures when the clinician has been accredited by Medical and Dental Appointments Advisory Committee. Surgical procedures should only be conducted at the hospital by an appropriately skilled clinician and where the infrastructure exists to enable the proposed procedure to be performed. 16 2.4 Completion of the Request for Admission Form (RFA) 17 2.5 Submitting a RFA 17 2.6 Processing a RFA 18 2.7 Listing Date 19 2.8 Variations from Standard Bookings 19 3 MANAGING PATIENTS ON THE WAITING LIST 20 3.1 Calculating Waiting Times 20 3.2 ‘Treat in turn’ 21 3.3 Clinical Review 21 3.4 Ready for Surgery (RFS) 22 3.4.1 Delayed Patients 22 3.4.2 Declined Patients 22 3.5 Not Ready for Surgery (NRFS) 23 3.5.1 Not Ready for Surgery – Staged Patients 23 3.5.2 Not ready for surgery – Pending Improvement of Clinical Condition 24 3.5.3 Not Ready for Surgery – Deferred for Personal Reasons 24 3.6 Admission Process 25 3.7 Hospital Initiated Postponement (HIP) 27 3.8 Patient Initiated Postponement: 28 3.9 Reporting of Hospital Initiated Postponements (HIPs) 29 4 DEMAND MANAGEMENT 29 4.1 Demand Management Escalation 30 4.2 Transferring Patients to another Facility for surgery 30 4.3 Removing Patients from the Waiting List 31 5 RECORD KEEPING 34 5.1 Postponement of Planned Admission 34 5.2 Removal of Patients from the Waiting List (other than admission) 34 6 AUDITING THE WAITING LIST 35 6.1 Clerical Audit 35 6.2 Request for Admission (RFA) Audit 35 7 DOCTOR’S LEAVE – TEMPORARY OR PERMANENT 36 7.1 Resignation, Retirement or Sudden Death 37 8 DEFINITIONS 38 9 APPENDICES 46 Appendix 1 - Patient Notification Letter 46 Appendix 2 – Audit letter 48 Appendix 2 – Audit letter 49 Appendix 3 - Removal from Waiting List Letter 50 Appendix 4 – Reclassification of Clinical Priority form 51 Appendix 5 – Notification to patient of Registration on the waiting list 52 Appendix 6 – Urgency Category outside National Guidelines 53 Appendix 7 – Letter to GP advising of patient who smokes 54 Appendix 8 – GP Notification Letter 55 Appendix 9 – Minimum Data Set Incomplete 56 Appendix 10 – Paediatric Notification Letter 57 10 REFERENCES 59 11 ACRONYMS 60 12 NATIONAL ELECTIVE SURGERY URGENCY CATEGORY GUIDELINE 61 CARDIO THORACIC SURGERY 61 OTOLARYNGOLOGY HEAD AND NECK SURGERY 61 GENERAL SURGERY 63 GYNAECOLOGY SURGERY 64 NEUROSURGERY 65 OPHTHALMOLOGY SURGERY 66 ORTHOPAEDIC SURGERY 67 PAEDIATRIC SURGERY 68 PLASTIC & RECONSTRUCTIVE SURGERY 69 UROLOGICAL SURGERY 70 * National guideline category changed by Urology Unit Director 70 VASCULAR SURGERY 71
1 INTRODUCTIONEach year approximately 12,000 people from the Australian Capital Territory (ACT) and the surrounding region have elective surgery as patients of the ACT public hospital system. Surgery is defined as procedures listed in the surgical operations section of the Commonwealth Medical Benefits Schedule. Surgery is classified as either emergency surgery, elective surgery or other surgery on the basis of a patient’s presentation and subsequent care. Emergency surgery is defined as surgery to treat trauma or acute illness subsequent to an emergency presentation. The patient may require immediate surgery or present for surgery at a later time following this unplanned presentation. This includes where the patient leaves hospital and returns for a subsequent admission. Emergency surgery also includes unplanned surgery for admitted patients and unplanned surgery for patients already waiting for an elective surgery procedure (for example, in cases of acute deterioration of an existing condition). Elective Surgery is defined as planned surgery that can be booked in advance as a result of a specialist clinical assessment resulting in placement on an elective surgery waiting list. Other surgery is where the procedure cannot be defined as either emergency surgery or elective surgery, for example, transplant surgery and planned obstetric procedures. Elective surgery in the public hospital system is provided through the use of waiting lists, which are registers of patients who are waiting for elective care. Patients are placed on a waiting list and assigned to a clinical priority urgency category depending on the seriousness of their condition. Clinical priority urgency categories 1, 2, and 3 referred to in this document are consistent with the National Elective Surgery Urgency Category guidelines developed in conjunction with the Australian Institute of Health and Welfare (AIHW) and the Royal Australian College of Surgeons (RACS) to enable improved consistency and reporting of elective surgery. The capacity of the public health system to provide elective surgery is influenced by a number of crucial factors. These include the demand for emergency surgery, demand for the surgical specialty, demand for hospital beds due to emergency and urgent medical care, the supply of surgeons, anaesthetists and nursing staff, theatre capacity, scheduling and management practices, and effective discharge planning of patients from hospital. Managing elective surgery and waiting lists is a key priority for the ACT Government and ACT Health. The community insists on transparency and accountability and patients expect timely, accessible and high quality patient-centred services. Failure to comply with ACT Health Policy may form part of ongoing divisional and/or individual performance reviews. Hospitals have a responsibility for ensuring compliance with the contents of this document, and that processes are in place to: Implement the framework Identify staff roles and responsibilities Validate the accuracy and integrity of reported data Regularly review individual hospital performance against Locally and Nationally set key performance indicators Train and educate staff managing elective surgery and the waiting lists The framework seeks to: Support active management of patients waiting for elective surgery Support best practice in elective surgery waiting list management Identify the rights and responsibilities of hospitals, referring surgeons and patients Improve communication among patients, hospitals, referring surgeons and community providers Support meaningful reporting to the public by hospitals and the government The following principles underpin the Policy: Referrals for elective surgery are clinically appropriate and are representative of a suitable treatment for the patient’s condition Patients are provided with easy to understand information about access to elective surgery and their rights and responsibilities Public patients are the shared responsibility of the hospital, the referring surgeon and the relevant specialty Patients waiting for elective surgery are fully informed about, and have consented to the procedure/treatment All documentation is complete, legible and accurate Waiting list management services are provided in an efficient, transparent and patient-centred manner The elective surgery waiting list is managed to ensure patients are treated equitably within clinically appropriate timeframes and with priority given to patients with an urgent clinical need The scheduling of surgery is undertaken in consideration of available capacity Hospitals minimise the impact and inconvenience to patients whose surgery they postpone The elective surgery waiting list is managed to promote the most effective use of available resources Patients are categorised in accordance with National Elective Surgery Urgency Categories There is valid, reliable and accountable reporting of access to elective surgery RESPONSIBILITIES Responsibilities of the Patient: Follow the procedures and advice outlined in the information provided Advise the hospital of any change in desire to undergo the procedure/treatment Follow hospital admission procedure and advise of any changes to the proposed admission, such as availability or change of address or other contact details Attend any preadmission appointments as required and present on the day of admission Responsibilities of the General Practitioner (GP): Arrange referral for patients to a hospital that has surgeons with the appropriate expertise and the least waiting time for the anticipated surgical procedure (outpatient waiting time and travelling time should also be considered) Provide the hospital with appropriate health information and personal details of the patient with referral Liaise with the referring surgeon if there is a change in any indications for surgery or a change in patient’s health that may have implications for surgery and treatment Responsibilities of the Surgeon or delegate (Registrar): Explain the proposed procedure/treatment, options for treatment and potential complications and the anticipated length of stay, using an interpreter if required. Explain that the procedure may be performed by another surgeon and/or another hospital Consent forms are to be completed and signed by the surgeon and patient contemporaneously 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 Assign a clinical priority urgency category for the procedure/treatment using the National Elective Surgery Urgency Category guidelines If a patient is classified as staged, the time interval when the patient will be ready for surgery should be indicated Ensure that Request For Admission (RFA) forms are legible and the minimum data set is completed Forward completed RFA’s directly to the Central Wait List Service within 5 working days of signing and dating the RFA Initiate prompt and appropriate communication with the referring GP regarding the proposed management of the patient Referring doctors should ensure that they are able to perform the patient’s surgery within the clinical priority urgency category timeframe that they assign (excepting patients who may require multimodality therapies as parts of their treatment plan e.g. some colorectal surgery). The referring doctor should advise the relevant hospital executive if they are unable to provide the service and discuss an appropriate management plan for the patient. As a result doctors should not submit category one RFA’s when they will be away during that period, unless they have pre-discussed a management plan with the relevant hospital. Such RFA’s will be returned to the surgeon to make such plans. Referring doctors must advise patients of their current waiting time for surgery if added to their elective surgery waiting list. This ensures the patient is informed about their approximate wait time and can make an informed decision regarding their care that may include proceeding with the referring surgeon, being referred to another surgeon and/or exploring other options such as utilising private health insurance. All clinicians are provided with their Wait List on a quarterly basis. This information will enable the clinician to provide patients with an accurate estimation of their current waiting times Review the waiting list and verify with the hospital Inform patients if a RFA is not accepted and the patient not placed on the elective surgery waiting list Responsibilities of the Central Wait List Office: Comply with local procedures/protocols for administrative processes that support this Policy Ensure all documentation and electronic data input is accurate, legible and complete Ensure procedures included in the excluded list of procedures are not added to the waiting list without approval from the Director – Territory Wide Surgical Services Responsibilities of the Surgical Booking Office: Comply with local procedures/protocols for administrative processes that support this Policy Undertake all relevant audits to ensure all documentation and electronic data input is accurate, legible and complete Assist in planning for patients surgery and patient notification for surgery and pre-admission appointments Review and management of all patients listed on the elective surgery waiting list Responsibilities of the Clinical Director of Surgical Services (TCH) / Director of Medical Services (CHC): Ensure clinician compliance with this Policy Promote efficient and effective waiting list management by clinicians within their hospital Liaise with the Director - Territory Wide Surgical Services for escalation of any issues Responsibilities of the Director of Territory Wide Surgical Services: Provide advice on Territory wide issues relating to surgery Review and manage applications to perform excluded procedures Promote compliance with this Policy Act as an adjudicator for issues that require resolution Download 0.95 Mb. 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