EvE - Emergency vs Emergency (Surgery)

EvE - Emergency vs Emergency (Surgery)


Westmead Hospital Division of Surgery and Anaesthetics is implementing a number of solutions to improve the surgical journey for Category 5 and 6 emergency patients. The project includes the development of pathways for patients to enable a more structured approach to the booking and completion of emergency surgery, including possible hospital admission avoidance for suitable patients. Business rules to ensure equity and clinical coordination and assessment. Reconfiguration of surgical sessions to improve efficiency, utilisation and the patient journey.

View a poster from the Centre for Healthcare Redesign graduation, May 2019.


  • Improve key performance indicators for emergency surgery by June 2019
    • Category 5 < 24 hours from 91% to 100%
    • Category 6 < 72 hours from 88% to 100%
  • Increase the amount of allocated emergency session minutes to meet current emergency surgery load by June 2020
  • Decrease the pre-procedural length of stay from 3.7 days to <1 day for Category 5 and from 4.2 days to <3 days 6 emergency surgery patients by June 2020.


  • Reduction of the average pre-procedural LOS for Category 5 and 6
  • Reduction of repeat cancellations
  • Improved booking process
  • Improved patient experience
  • Reduction of unnecessarily long pre-operative fasting
  • Improved coordination and communication.


Due to the growing population, there is an increasing demand on surgical and procedural services for Western Sydney Local Health District. Capacity and coordination deficits within most procedural service units has the potential to have negative impacts on patients, their carer’s, staff and the facility. The redevelopment of Westmead Hospital provides an opportunity to change our business processes to ensure we maximise the use of current and future theatre spaces.

Emergency procedures are categorised according to clinical priority, this is assigned by the treating medical team in consultation with the duty anaesthetist of the day. It is common place for a lower category or less acute emergency procedures to be deferred on the day of surgery due to more acute bookings. This has led to many patient complaints, increased length of stay (4.3 days average pre-procedural LOS [all surgery]) and less than optimal outcomes for some patients.

Additionally there is considerable pressure placed on the clinicians to complete as much surgery as possible within the confines of the surgical schedule.

Westmead Hospital provides more emergency surgery than elective surgery on a yearly basis. There is an identified gap between ‘planned’ emergency sessions and completed emergency sessions. Of all emergency surgery, 48% are category 5 and 6, orthopaedic surgery provides the largest volume of category 5 and 6.

This project sees to improve access to emergency surgical treatment, efficient utilisation of resources and improvement to the patient experience and health outcomes by June 2019.


  • Identification of the problem through various tools and processes e.g. face to face workshops and surveys.
  • Confirmed problem and validation with key stakeholders and consumers.
  • Production of communication material and regular communication with key stakeholders.
  • Developed and researched best practice solutions.
  • Tested solutions with key stakeholders and consumers:
    • Emergency surgery pathways and emergency surgery booking business rules
    • Emergency surgery coordination meeting workflow and communication pathway.
  • Maximising efficiency of allocated emergency sessions.
  • Planning for implementation and resources required.
  • Designed data requirements for evaluation and monitoring.


Pre-implementation - Planning for the initiative is well underway. Clinician and/or consumer consultation has occurred.


  • Project initiated April 2018
  • Status - ongoing as of April 2019

Implementation site

Westmead Hospital


Centre for Healthcare Redesign


Pre-planning results

  • Increased emergency hours / sessions from 13% to 26%.
  • Decreased average pre-procedural length of stay in Cat 5 from 3.7 to 3.0.
  • Decreased average pre-procedural length of stay in Cat 6 from 4.2 to 6.7.
  • Developed coordination meeting workflow.

Lessons learnt

  • Each patient’s journey is different and pathways and business rules need to be adaptable.
  • Communication is key to ensuring wide acceptance and take up  of practice change.
  • Patients and their carers need to be  involved as much as possible in solutions.

Further reading


Lee-Ann McDonald
Senior Nurse Manager – Perioperative
Westmead Hospital
Western Sydney Local Health District
Phone: 02 8890 7900


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SurgeryLength of stayPatient flowWestern SydneyEmergencyRural and regionalCentre for Healthcare Redesign
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