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Case 15, Australian Surgery Indicator Makes the Front Page
Case 15: Australian Surgery Indicator Makes the Front Page
The front page of the Sydney Morning Herald of February 28, 2011, carried an exclusive headlined, Thousands Hit as Hospitals Cancel Surgery (Wallace, 2011). It cited public records from NSW Health, the ministry responsible for monitoring New South Wales state health system. The records indicated that same-day surgery cancellations were occurring regularly at three times the accepted standard. Many patients showed up at public hospitals operated by area health services expecting to go into the operating room, only to be sent home after fasting and having blood samples sent to the lab. In many instances, surgeries were canceled because the hospitals did not have beds waiting for the patients after their surgeries.
The article noted that the ministrys Surgery Dashboard, a monthly snapshot of key performance indicators, sets a target of less than 2% for surgery cancellations. This is a stretch or aspirational goal, and some NSW hospitals were not meeting the previous standard of less than 5%.
The Surgical Service Taskforce developed the dashboard, and NSW Health incorporated it into its Pre-Procedure Preparation Toolkit, a guideline issued by the ministrys Health Service Performance Improvement Branch. Table 15-1 lists the key performance indicators for both state and local levels.
The guideline indicators and targets were reviewed in November 2012, and the canceled surgeries target remained unchanged.
The reporter interviewed the chair of the local Australian Medical Association hospital practice committee, who was also a medical school faculty member. He suggested that the problem was worse than indicated, because patients who wanted surgery but were never booked were not counted. He observed that the benchmark percentage was ambitious but clearly double or triple that figure is unacceptable. He called a ministry plan to add 400 public hospital beds per year insufficient.
The deputy director-general of NSW Health told the reporter that 4045% of the cancellations were for patient reasons, such as the patient not showing up or being ill on the day of surgery. He also noted that there were multiple reasons why hospitals could not accommodate surgery patientswhen trauma patients unexpectedly tied up ICU beds, for example, or when necessary supplies and equipment were not available. He noted that when the benchmark had been less than 5% nearly all the hospitals had met it, so it was raised to an aspirational level of less than 2% in 2007.
Data extracted from the monthly reports by the newspaper indicated that some hospitals were usually failing to meet the less than 5% target and few had come close to the less than 2% level on a consistent basis. The same-day cancellation rate for six of the nine local hospitals was around 4%. This suggests that almost 9,000 same-day surgeries are canceled in New South Wales each year. The deputy observed that a cancellation rate of 45% was typical of other Australian states and that 91% of elective surgeries were completed on time.
Table 15-1 Key Surgical Performance Indicators
State Level
Booked patient cancellations on the day of surgery for any reason < 2.0%
Patients canceled due to medical conditions (included above) < 1.0%
Suggested for Local Level
Patients through the preprocedure preparation process 100%
Percentage of patients processed by: Target locally determined
Telephone interview
General preadmission clinic
Multidisciplinary preadmission clinic
Average time spent by patient in preadmission clinic
General (anesthetist and nurse) 2 hours
Multidisciplinary 4 hours
Other
Patients who do not attend on the day of surgery < 0.5%
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Source: Data from: NSW Department of Health, Guideline: Pre-Procedure Preparation Toolkit, Document GL-2007_018, 02-Nov-2007, p. 18. Accessed December 9, 2013, at www.health.nsw.gov.au/policies/gl/2007/pdf/GL2007_018.pdf
Referenced
McLaughlin, C. P., & McLaughlin, C. D. (2014). Health policy analysis: An interdisciplinary approach (2nd ed.). Jones & Bartlett Learning.
Case 15, Australian Surgery Indicator Makes the Front Page
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Excellent Quality 95-100%
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Introduction
45-41 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Literature Support 91-84 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Methodology 58-53 points Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met. |
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Average Score 50-85% |
40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided. |
83-76 points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration. |
52-49 points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met. |
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Poor Quality 0-45% |
37-1 points The background and/or significance are missing. No search history information is provided. |
75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration. |
48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met |
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Case 15, Australian Surgery Indicator Makes the Front Page |
Case 15, Australian Surgery Indicator Makes the Front Page