Percentage of elective wait list patients waiting over boundary for reportable procedures
Rationale
Elective surgery refers to planned surgery that can be booked in advance following specialist assessment that results in placement on an elective surgery waiting list.
Elective surgical services delivered in the WA health system are those deemed to be clinically necessary. Excessive waiting times for these services can lead to deterioration of the patient’s condition and/or quality of life, or even death. Waiting lists must be actively managed by hospitals to ensure fair and equitable access to limited services, and that all patients are treated within clinically appropriate timeframes.
Patients are prioritised based on their assigned clinical urgency category:
- 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.
On 1 April 2016, the WA health system introduced a new statewide performance target for the provision of elective services. For reportable procedures, the target requires that no patients (0%) on the elective waiting lists wait longer than the clinically recommended time for their procedure, according to their urgency category.
Target
The 2021-22 target for patients waiting over boundary for all urgency categories is 0%. A result equal to target is desired.
Results
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Category 1
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021-22 | Target 0% | Actual 6.5% |
|
| Year 2020-21 | Target 0% | Actual 19.6% |
|
| Year 2019-20 | Target 0% | Actual 27.0% |
|
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021-22 | Target 0% | Actual 28.3% |
|
| Year 2020-21 | Target 0% | Actual 27.7% |
|
| Year 2019-20 | Target 0% | Actual 18.9% |
|
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021-22 | Target 0% | Actual 9.3% |
|
| Year 2020-21 | Target 0% | Actual 8.6% |
|
| Year 2019-20 | Target 0% | Actual 3.3% |
|
Commentary
In 2021-22, EMHS endeavoured to meet the clinical waiting times recommended for the urgency categories.
The restrictions placed on hospital elective surgery waitlists during the year due to COVID-19, and together with the increasing emergency surgery demand, has greatly impacted the elective surgery waitlist over boundary initiatives across all urgency categories.
EMHS implemented several key initiatives to manage the elective surgery waitlist, that included:
- targeted activity increases to reduce the patients waiting for an endoscopy was achieved between July and December 2021. This reduced over boundary cases by 85% before the elective restrictions were put in place in the first half of 2022
- additional theatre lists across multiple specialties to reduce the over boundary waitlist
- all sites targeted patients waiting over boundary across all specialties and categories.
Managing timely access to elective surgery in 2021-22 continued as a focus across EMHS, with improved performance in timeframes for urgency category one. However, some specialties continue to have access challenges due to increases in emergency demand and workforce shortages.
To maintain a sustainable elective surgery waitlist, EMHS has implemented longer term strategies that include:
- continuation of individual specialty management plans to maintain the ongoing waitlist demand by managing the demand and over boundary cases
- recommencement of selective specialty procedures in accordance with the British Association of Day Surgery (BADS) suitable for day surgery and reduce multiday admissions
- targeting the efficiency of elective surgery theatre utilisation across sites.
Period: 2019-20 – 2021-22 financial years (average of weekly census data)
Contributing sites: Armadale Health Service, Bentley Health Service, Kalamunda Hospital, Royal Perth Hospital, St John of God Midland Public Hospital
Data source: Elective Services Wait List Data Collection
Outcome one // Effectiveness KPI