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Improving Surgical Access for Patients

Project Added:
18 March 2016
Last updated:
28 April 2016

Improving Surgical Access for Patients (ISAP)


This project simplified the admission and bookings process for elective surgeries at Westmead Hospital, by introducing administration procedures including monthly speciality waiting list reports, a local policy compliance procedure and SMS reminders for patients.

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

ISAP poster


To improve patient notifications of clinical category 2^ and 3# vascular and urology elective surgery dates, from 28.5% and 12.9% respectively, to 5% by March 2016.

^procedures clinically indicated within 90 days
#procedures clinically indicated within 365 days.


  • Improves reliability, planning and preparation for patient procedures.
  • Improves service delivery across all surgical specialties.
  • Improves patients’ experience and access to surgical services.
  • Reduces cancellations and rescheduling of surgical procedures.
  • Improves communication between teams who interface with the admissions and bookings office.
  • Improves efficiency of operating theatres and human resources.
  • Improves National Elective Surgery Target (NEST) and rescheduling performance.
  • Increases morale and retention of staff.


Prior to the project, each of the 15 surgical specialties at Westmead Hospital had different methods of creating surgical lists, making bookings and preparing for admissions. In addition, recommendation for admission (RFA) forms were often incomplete or incorrect. This led to patients being treated out of turn, cancelled or called at short notice (disrupting plans for their procedures), with bookings and admissions staff wasting time trying to collect missing information. This cost the organisation 0.91 full time equivalent, or approximately $50k at Administration Officer Level 3.

An audit was undertaken of all surgical specialties at Westmead Hospital between May 2014 and April 2015.  It found that 3175 patients were cancelled, with 426 cancelled on the day of surgery.  It also showed that 50% of all elective surgery cancellations occurred within 1-7 days of the planned date of admission.  Approximately 900 clinical category 2 and 3 patients were given a surgery date 1-7 days prior to their planned date of admission.

With an increased demand for elective surgery of 15% from June 2013 to July 2014 (14,260 patients), it was clear that a solution was required that streamlined and improved the bookings and admissions process across all 15 surgical specialties.


  • Introduced a specialty list led by the head of department, to gain flexible access to surgery within each department and maximise use of the available schedule.
  • Developed a monthly specialty waiting list report, to identify patients who are next in line for surgery within each department. This allows WSLHD to see which departments are breaching the waiting time and how to manage this with available resources.
  • Created a local policy compliance procedure to identify key contacts and escalation pathways within Westmead Hospital.
  • Developed a stamp for the RFA form, which allows clinicians and admissions staff to identify patients who are suitable candidates for surgery at short notice, based on readiness for surgery, access to Westmead Hospital and length of procedure. A message was also broadcast to clinicians at Westmead Hospital regarding eligibility for the ‘short notice’ stamp.
  • Allocated an admissions and bookings officer, who provided a theatre list for their designated specialty. This was designed to streamline the booking process across all 15 surgical specialties, while customising lists to the needs of the specialty.
  • Determined that incomplete RFA forms for clinical category 2 and 3 patients will no longer be accepted and responsibility for following up on missing information lies with the referring clinician.
  • Developed SMS reminders and confirmations to patients, regarding their planned date of admission. Patients are asked to confirm their attendance 10 days prior to admission and provided with contact details if they have any concerns or questions.

Project status

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

Key dates

  • April 2015 – March 2016

Implementation site

  • Westmead Hospital, Western Sydney Local Health District



  • To date, the following results have been achieved:
    • patients are impacted by the short notice service, but are generally happy with the service provided
    • over 50% of patients have responded to SMS notifications to confirm their attendance on the planned date of admission.
  • A full evaluation of project outcomes was completed in March 2016.
  • The following measures will be undertaken to determine the outcomes of the project:
    • monthly specialty waiting list reports to measure wait times across all specialties
    • staff surveys to measure feedback on local policy compliance procedure
    • audit of complete and incomplete RFA forms received
    • number of patients allocated to short notice waitlist
    • patient surveys to measure feedback on SMS service
    • use of SMS service and impact of attendance on planned date of admission.

Lessons learnt

  • This redesign has had a remarkable influence on the cultural change of the organisation, with greater awareness of silos within departments and surgical services.
  • Engaging clinicians has occasionally been difficult, due to competing demands of the service they are providing.
  • The enormity of the process meant that our scope was narrowed specifically to the admissions and bookings process and two specialties within the service.
  • Electronic communication could be problematic for stakeholders who have competing demands.
  • If we could do things differently, we would engage stakeholders earlier in the process and implement more face-to-face communication.

Further reading


Brian Julien
Project Officer
Westmead Hospital
Western Sydney Local Health District
Phone: 02 8890 6623

Margaret Wall
Surgical Access and Waitlist Manager
Western Sydney Local Health District
Phone: 02 9845 5692

Carmen Hoffmann
Project Officer
Westmead Hospital
Western Sydney Local Health District
Phone: 02 8890 6623

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