Expert Panel - Review of Elective Surgery and Emergency Access Targets under the National Partnership Agreement on Improving Public Hospital Services: Supplementary Annexure
4.14 Northern Territory - Royal Darwin Hospital (RDH) 23 hour ward model
DescriptionTheatre staff, including the Theatre Schedulers, identified that there was a cohort of patients who required elective surgery, who were not suitable to undergo surgery as a day patient, even though their elective surgery procedure was normally undertaken as a day case.
The patient’s personal circumstances (for example, they did not have family support at home or were frail aged) meant that they would need to be booked as an overnight patient which was placing further pressure on access to hospital beds.
To address the issue, it was decided that five beds would be set aside in the Same Day Procedure Unit for overnight cases. The Theatre Schedulers, when developing the theatre lists, would include five patients who required an overnight stay. Certain patients booked for ear, nose and throat (ENT), ophthalmology and laparoscopic surgery were identified as the types of cases that benefited most from an overnight stay.
Same Day Procedure Unit nursing staff were rostered for the night shift and with the assistance of nursing staff from the Recovery Room they provided treatment and care to patients overnight and prepared them for discharge in the morning.
RationaleThis new initiative came about as a result of recognising that some patients, due to their specific circumstances, were not able to be treated as day surgery patients.
OutcomesThe 23 hour ward model has been piloted since July 2010. Initially it was implemented as a five day a week model but due to scheduling reasons, it was found to work more efficiently on a three day a week basis.
The 23 hour ward model has:
- Increased elective surgery throughput of appropriate general, ophthalmology and ENT surgery; and
- Assisted with managing access block.
Two of the key success factors for this model are being able to clearly identify which patients on the elective surgery waiting list are appropriate for a 23 hour stay and ensuring that discharge planning must commence at the point of admission to facilitate discharge by 10am the following day.