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eSURG: Streamlining the Admission Process for Surgery at St George Hospital

Project Added:
20 April 2015
Last updated:
22 April 2015

eSURG - Streamlining the Admission Process for Surgery at St George Hospital


The project will improve the Recommendation for Admission (RFA) process for patients undergoing upper gastrointestinal surgery. The solutions developed will simplify the process for patients, surgeons and admissions staff by reducing inefficiencies and unnecessary delays.

Poster from the Centre for Healthcare Redesign graduation, April 2015

Poster from the Centre for Healthcare Redesign graduation, April 2015.

The Admissions office with attendant on the phone


To streamline the admission process and reduce elective surgical waiting times at St George Hospital for upper gastrointestinal surgery and vascular surgeries.


  • Reduces inefficiencies and staff workload.
  • Simplifies the process for patients and improves navigation of the hospital, therefore improving patient experience.
  • Simplifies the process for surgeons.

Project Status 

Project status: Implementation - the initiative is ready for implementation, is currently being implemented, piloted or tested.


This project was based on anecdotal evidence from admissions staff at St George Hospital, who shared concerns that the complex admission process was contributing to the delay in booking patients for surgery within a clinically appropriate timeframe. This delay was affecting the hospital’s National Elective Surgical Target (NEST) performance.

It was found that admission forms were too complicated and collected too much data, resulting in patients and surgeons not being able to complete the form. This meant admission staff had to chase up information and deal with difficulties in determining bypass for patients attending the pre-admission clinic. Patients were also burdened by having to hand-deliver admission forms, with the hospital layout and lack of directional signage increasing this burden.

These issues did not directly affect NEST performance, however it contributed to an increase in average wait time of 23 days on top of NEST wait times. 


The following solutions were identified for their ability to be influenced as well as their overall impact.

  • Redesigned RFA form to simplify data collection and meet policy requirements.
  • Redesigned Patient Health Questionnaire (PHQ) to include only required information, written in plain English so it can be understood by all patients.
  • Implemented policy that RFA forms are to be entered electronically, for legibility.
  • Implemented policy that RFA forms are to be delivered either by fax or email to ensure fast delivery.
  • Implemented policy that RFA forms will not be accepted unless all mandatory areas are complete.
  • Created new admission and pre-admissions signage in the hospital, to assist patient navigation.
  • Developed new maps for inclusion in patient admission packs.
  • Procured an SMS service to remind patients of appointments via text message.

Implementation site

  • St George Hospital


  • Sutherland Hospital
  • Prince of Wales Hospital


  • The diagnostic phase involved interviewing patients, so future responses can be compared against a baseline.
  • New maps and signage are expected to improve patient satisfaction and reduce delays in finding pre-admission clinics and day surgery areas.
  • The electronic RFA is expected to reduce the time it takes patients to submit forms and improve the timeliness of placing patients on the wait list.
  • The SMS service is expected to reduce cancellations on the day of surgery and no shows for Pre Admission Clinic (PAC). The service application is approved and implementation is in progress.
  • The redesigned PHQ is expected to result in higher rates of completion, as the form is more easily understood by patients.

Results of the project are expected by 30 June 2015, and will include the following measures.

  • Average number of days taken to receive RFAs, from 22 to 3 days.
  • Percentage of RFAs which are legible, from 13% to 100%.
  • Percentage of RFAs are complete, from 73% to 100%.
  • Percentage of patients easily able to locate the admissions office, from 66% to 90%.
  • Percentage of patients easily able to locate PAC, from 44% to 90%.
  • Percentage of RFAs received by fax or emails, from 18% to 100%.

Lessons Learnt

  • Changing one thing can set off a domino effect in other areas, so before implementing a change it’s important to see what effect the project will have on the rest of the organisation.
  • Information technology (IT) involvement will always delay a project.
  • Provide evidence when explaining the case for change. For example, video the patient journey to demonstrate the lack of signage and to pre-admissions process.
  • Reporting to a district committee resulted in the involvement of other sites, who did not want decisions at one hospital to affect business practices across the district. As any form changes needed to occur across all sites, a larger consultation base was required. This highlighted the fact that each site was using the same form but had different business practices to support its use.
  • Improving signage was a challenge, as St George Hospital is currently undergoing a redevelopment and the facilities unit was reluctant to upgrade signage before works are completed.
  • The SMS service was unable to be applied at only one site. The IT unit advised we needed to implement the SMS service across all sites simultaneously, with the same messages sent out from each site. This resulted in an extended consultation process, which led to delays.
  • Realising each site used the same form in different ways.
  • Discovering that the RFA form was developed by Prince of Wales Hospital and was designed to suit its processes.
  • Realising that the secretaries of surgeons did not know the process.


Sarah-Jane Messum
Surgical Access Officer
South Eastern Sydney Local Health District
Phone: 0413 616 292

Dorcas Lau
Quality Manager, St George & Sutherland Hospitals
South Eastern Sydney Local Health District
Phone: 02 9113 2187

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