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Bowral and District Hospital Preadmission Clinic Redesign Project

Project Added:
9 December 2016
Last updated:
16 December 2016

Bowral and District Hospital Preadmission Clinic Redesign Project


This project reviewed the journey of adult elective surgery patients at Bowral and District Hospital (BDH) and developed a series of measures to streamline and improve the booking, pathology, clinical review, admission, surgery and post-operative processes.

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


To increase the overall efficiency of the preadmission clinic (PAC) at BDH and improve the patient experience, by clinically assessing 100% of referrals for surgery within seven days of submission and reducing day of surgery cancellations to  less than 1.5%, by June 2017.


  • Reduces PAC and day of surgery cancellations or deferrals.
  • Reduces length of stay in the PAC.
  • Improves hospital efficiency and operating theatre utilisation.
  • Increases patient and staff satisfaction.
  • Streamlines PAC booking processes and reduces waiting time.
  • Improves National Elective Surgery Target (NEST) performance.
  • Provides guidelines and management plans for elective surgery patients.
  • Improves documentation and capabilities of electronic medical records (eMRs).


In 2014, 19% of all referrals for elective surgery at BDH were reviewed in the PAC. 4.6% of these patients had their elective surgery cancelled, with another 1.5% cancelled on the day of surgery due to patient-related issues, including respiratory disease, obesity, heart disease and haematological disorders. Many of these patients had been on the waiting list for up to 12 months, which caused stress and dissatisfaction with the service. This led to a significant number of complaints to the patient liaison officer, as well as a loss of productivity and inefficient use of resources within BDH.

It was determined that standardising and streamlining the PAC process would reduce the risk of cancellations, resulting in improved access to and coordination of care, as well as improved patient and staff satisfaction.


  • Consultation, focus groups and interviews with clinicians who provide care to elective surgical patients at BDH was undertaken in April 2016. Potential solutions were identified and put forward as recommendations to the Project Management Committee.
  • All Request For Admission (RFA) forms were clinically reviewed at the time of submission, with patients who have significant risk factors identified and selected to attend the PAC early in their healthcare journey. This ensured appropriate assessment and management of their condition. These patients attended the PAC again prior to surgery, for a final review.
  • PAC bookings were changed to a timed rather than block system, to reduce the length of stay for patients.
  • Patients were provided with the option to have pathology tests completed prior to attending the PAC, to reduce waiting time.
  • A system was developed to follow up patients who were not ready for care for medical reasons.
  • Guidelines will be established to clarify patient suitability for elective surgery at BDH. These guidelines will be circulated to the Primary Health Network and remain in effect until a formal policy is developed by South Western Sydney Local Health District (SWSLHD).
  • A management plan for patients who are unsuitable for elective surgery at BDH will be developed, to facilitate their transfer to another facility.
  • Improvements to documentation and enhancements to eMRs will be undertaken, to improve access to and reduce duplication of patient data.

Project status

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

Key dates

February 2016 – June 2017  

Implementation sites

Bowral and District Hospital, SWSLHD



  • A final evaluation will be undertaken in June 2017, with measurement of the following outcomes conducted on a monthly or quarterly basis:
    • number of RFAs reviewed
    • number of patients who require early review
    • number of patients not ready for care
    • NEST performance
    • capacity of the PAC to care for patients who require early review
    • average length of stay in the PAC
    • PAC and day of surgery cancellations or deferrals
    • staff and patient satisfaction, measured by surveys
  • Clinical review of RFAs commenced in November 2016.

Lessons learnt

  • Quick things take time and they’re never as easy as they seem.
  • Keeping to a timeframe while the project team had competing demands was the biggest challenge.
  • Learning new principles through the Accelerating Implementation Methodology (AIM) Workshop and applying those principles to the project was invaluable. It also provided a great opportunity to learn new practical skills.

Related resources


Grant Isedale
Director of Clinical and Support Services
Bowral Hospital
South Western Sydney Local Health District
Phone: 02 4861 0288

Tania Kasjan
Registered Nurse, Operating Room and PAC
Bowral Hospital
South Western Sydney Local Health District
Phone: 02 4861 0217

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