When hospital emergency departments are overloaded with patients, bed managers may consider managing the surge in demand by cancelling planned surgery to reduce the need for post-operative beds.
However, this can negatively impact on patients awaiting surgery and waitlist performance measures.The NSW Ministry of Health set a target for Murrumbidgee Local Health District (MLHD) to reduce the number of overdue planned surgeries by December 2023. Overdue cases that had accumulated on the waiting list were due to elective surgery access restrictions during the COVID-19 pandemic and post COVID-19 issues with workforce availability. Patients were exceeding their clinical urgency category and theatre availability was reducing due to nursing and medical workforce challenges.
MLHD opened a High Volume Short Stay Unit (HVSSU) in January 2023 to manage the overdue cases by December 2023. The district had previously been set a 000 target in 2020, and successfully reduced overdue patients by opening a HVSSU co-located within the Perioperative Day Surgery Unit. The unit was closed on 30 June 2021. The new HVSSU was opened in a ward to allow better utilisation with twelve beds available.
The goals of the unit included:
- improved access to planned surgical services both intra and post operatively
- improved service efficiency for theatre and bed utilisation
- increase in numbers for overnight bed capacity post operatively, whilst controlling “bed days”
- the ability for Wagga Wagga Base Hospital to flex up and down dependent on hospital needs
- increase predictability of estimated dates of discharge.
Maximising occupancy of theatre beds
The unit identified patients suitable for a short-stay surgical model on the waitlist using a defined selection criteria determined by MLHD executive and key internal stakeholders (e.g. surgeons, waitlist managers, whole of hospital team and patient flow managers). During weekly theatre bed meetings with the Whole of Hospital team, patients were allocated to the HVSS unit with a view to maximising occupancy and keeping all twelve beds used. After-Hours Bed Managers managed and documented the allocation of patients to these beds to ensure placement of patients aligned with project objectives and best practice care, rather than simply moving patients from the emergency department to the ward.
Reduction in requirements for surge bed activity
The unit has been successful due to proactive management of the beds access across the board. Early results of implementation indicate that the HVSS model has:
- achieved a reduction in the requirements for surge bed activity
- assisted Wagga Wagga Base Hospital to maintain a transfer of care rate of 90% and compared to previous time in previous years
- reduced the volume of patients sitting in the emergency department for more than 24 hours by 35%.
