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GynaeLogical: It Makes Sense to Care for Women

John Hunter HospitalBelmont Hospital
Project Added:
2 December 2016
Last updated:
16 December 2016

GynaeLogical: It Makes Sense to Care for Women


This project streamlined its booking and referral processes, standardised templates and introduced electronic systems to ensure all patients received timely and appropriate care.

View a poster from the Centre for Healthcare Redesign graduation, December 2016.


To improve patient and staff satisfaction by:

  • decreasing the number of incomplete referrals received from 51% to less than 5% by December 2017
  • decreasing clinic appointment overbookings from 100% to a maximum of 10% by December 2017
  • decreasing the number of Did Not Attend (DNA) appointments from up to 16.6% to less than 5% by December 2017.


  • Improves access to specialist gynaecology services.
  • Reduces wait time for initial consultations at gynaecology clinics.
  • Increases availability of clinic appointments.
  • Reduces emergency department presentations for gynaecological conditions.
  • Reduces instances where patients DNA and associated costs.
  • Reduces the number of appointments required to address the patient’s issues.
  • Improves satisfaction of patients, staff and general practitioners (GPs).
  • Enhances collaboration and communication between GPs and clinic staff.
  • Streamlines processes to maximise efficiency and eliminate duplications.


In early 2016, the gynaecology outpatient clinics at John Hunter Hospital were operating above capacity, with the average number of documents received increasing from 315 per month in 2015 to 475 per month in 2016. A number of complaints were received from patients about the long wait time and lack of available appointments. In some cases, patients were waiting up to 12 months for an appointment. Staff also voiced complaints about the lack of information available in referrals and the high number of DNA appointments.

An audit conducted in March 2016 found that 51% of gynaecology referrals were delayed due to incomplete information in the referral, which may significantly impact patient care. It also showed that there were 1200 DNA patients, which equates to more than $86,000 in lost Medicare billing. In addition, there was a deficit of 1500 new appointments to accommodate new referrals. This led to dissatisfaction among patients, GPs and staff specialists. GPs were also frustrated due to the lack of information provided by the clinics about their patients.


  • Extensive audits and interviews were conducted in March and April 2016 with patients and staff, to discover the root cause of the problem.
  • All gynaecology referrals were pooled into one system and triaged by senior nurse clinicians.
  • Letter templates to GPs and patients were revised to ensure all relevant information was included.
  • Clinic templates were standardised to improve the availability of initial clinic appointment times.
  • HealthPathways (an online tool to help GPs identify and manage their patients’ conditions) were developed to support GPs. 95% of these have been completed as of December 2016.
  • Electronic systems were created to enhance communication with GPs. These included eReferrals and GynaePlus, which is a database that audits all clinic activity and can generate letters to GPs in real time. It will be introduced into the live environment in February 2017.
  • Strategies will be developed to engage Aboriginal and culturally and linguistically diverse women, ensuring that all services are culturally appropriate. These will include regular meetings at the Aboriginal Health Centre and liaison with the Aboriginal Women’s Health social work team.

Project status

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

Key dates

  • Project start: March 2016
  • Implementation of eReferrals and GynaePlus: February 2017
  • Final evaluation: March 2017

Implementation sites

Gynaecology Outpatient Clinics at John Hunter and Belmont Hospitals, HNELHD



  • Data from referral and patient information systems will be collected each month from March 2016, to measure downward trends in:
    • number of incomplete referrals
    • DNA appointments
    • clinic overbookings.
  • Surveys of patients, staff and GPs will be conducted in March 2017 and then annually.
  • Clinic overbookings reduced from 100% in March 2016 to 33% in October 2016.
  • DNA rates reduced from 16.6% in March 2016 to 14% in October 2016.

Lessons learnt

  • Good communication with GPs is important. Information exchange between gynaecology clinics and primary healthcare professionals must be efficient to ensure continuity of care and best practice for patients.
  • Staff specialists may resist changes to the way they run their clinics. Support and information is needed to ensure the transition is as smooth as possible.
  • Physical limitations such as space are difficult to overcome and need a whole service approach.
  • Remaining positive and championing the cause definitely helps!


Kathy Bourke
Clinical Nurse Consultant Gynaecology and Women’s Health
John Hunter Hospital
Hunter New England Local Health District
Phone: 02 4922 3399

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