A project team from Maitland Hospital is realigning surgical access with patient demand – aiming to improve cancellation management, governance processes and patient and staff experience.
Maitland Hospital is one of the largest facilities in Hunter New England Local Health District (HNELHD), built on the traditional lands of the Wonnarua people. In January 2022, Maitland Hospital relocated from its original campus to a new building; this was a same-level transfer of service, with no increase in any specialty services.
The number of theatres has increased from 4 to 8 and now includes 2 endoscopic procedure rooms and a cardiac catheterisation laboratory. Despite this change in location and physical space, the hospital continues to use the same business model as 2011. There are 3 operating theatres in use daily, with a fourth available for life-threatening emergencies. In addition, following the model in use since 2017, one out-of-hours unplanned theatre is run weekday evenings, with unplanned access available Saturday and Sunday.
On relocation, the facility experienced an immediate increase in emergency department (ED) presentations and inpatient admissions, increasing the volume of unplanned procedures competing for theatre time. According to HNELHD performance data, ED presentations have increased by 7.2 % year on year as of June 2024.
In 2023, an average of 45% of total surgeries were unplanned in NSW, At Maitland Hospital in the 2024 financial year, 60% of surgeries were unplanned.
Better experience, better outcomes
Timely access to theatre will provide better patient health outcomes and better experiences for patients and staff. In 2021, the Agency for Clinical Innovation released guidance for improving emergency surgery services – the project team has used this guidance as a basis for this project.
Diagnostics involved a detailed data analysis of theatre activity for the past 10 years; a review of recent performance data; consultation with staff, feedback analysis and interviews with consumers; and consultation with stakeholders undertaken through workshops, surveys, process mapping and polls.
The project team performed a detailed analysis of this data, identifying the folllowing issues and root causes:
- high unplanned workload across major specialties and failure to meet surgical performance KPIs, compounded by limited access, resulted in high cancellations of elective and unplanned surgery
- haps and inconsistency in prioritisation of workflow
- gaps and inconsistency in prevention and management of cancellations and delays in access and related negative fasting experience
- gaps in communication between stakeholders and with patients
- staffing and resource shortages.
Addressing patient demand and governance structures
During the solutions phase, the project team mapped a total of 9 solutions.
- Dedicated planned and unplanned theatres. The project team has established separate unplanned theatre sessions. These initially started at 50 hours per week, later progressing to 70 hours perk week. The team created additional elective theatre capacity by commissioning a fifth theatre.
- Matching session allocations with demand. This was utilised initially for a waitlist recovery program where overdue and impending overdue cases were addressed as priority. Subsequent allocations of theatre for long-term are being matched with the proportion and volume of the waitlist demand. This is based on the total waitlist load by each specialty in terms of case numbers and theatre time and working out a proportion of allocation for each specialty.
- Shared live unplanned run sheet. This tool is under development and will assist in providing a visual compilation of all unplanned cases that are booked and prioritised across all departments. This will also include comments about any change in prioritisation order, allocation to theatre, equipment or other resource issues, and patient-related issues that the team needs to be aware of in theatre planning.
- Theatre safety huddle. A safety huddle combines all key leaders in theatre at the beginning of the day, to discuss the order of the cases and any clinical priorities and risks, and to plan the activity for the day. The project team is preparing terms of reference and standard templates for the huddle to help implement this solution.
- Virtual surgical ward. A virtual surgical ward is a concept to admit a patient to a virtual bed when they require semi-urgent surgery but are safe enough to wait at home for surgery while the planning takes place. This helps create an admitted episode for documentation of all communication, care escalation and management. The project team has successfully activated virtual bed configuration in the patient management system. Back-end process is being mapped, and education is being planned to implement this model of care.
- Refocus on the role of the Orthopaedic Service Coordinator. As the Orthopaedic Service Coordinator will play an important role in implementing some of the solutions, a refocus of this role is a key solution strategy. The current role focuses more on outpatient services and less on unplanned surgeries. This has been changed to a focus on unplanned surgery and implementation of virtual surgical ward model of care to manage the patients waiting unplanned surgery.
- Review of theatre governance and cancellation management. The Surgical Services Committee has initiated a theatre governance and cancellation management review, with the aim to develop and update the perioperative services management procedure and policy documents. The changes will focus on strategies to prevent cancellations, escalation to executives, prioritisation in rescheduling processes, communication protocols and clarification of responsibility to communicate to relevant stakeholders in a timely manner.
- Utilising procedure rooms outside theatres. This solution will be undertaken separately, outside the scope of this project.
- Centralised surgical network for recruitment, sharing of staffing and resources. This solution will be undertaken separately, outside the scope of this project.
Initial reduction in unplanned and overdue elective surgeries
By comparing data from June 2024 to June 2025, the project team has achieved the following:
- Use of elective sessions for unplanned cases have decreased from 55.6% to 22.1%
- Unplanned access within 8-, 24- and 72-hour triage time categories has improved from 89%, 74% and 75% respectively to 100%, 90% and 87% respectively as in June 25.
- Overdue elective surgeries (in category 2 and 3) have been reduced from 286 to just 36 cases at the end of June 2025.
- Complaints have reduced from 6% to 3.7% based on the previous six-month average.
- Day of surgery cancellations have been reduced from 8.8% in June 2024 to 7.16% in June 2025.
View this project's poster from the Centre for Healthcare Redesign graduation August 2025.
