When’s it my turn? The Maitland Hospital Paediatric Ambulatory Care Service

Published 27 August 2018. Last updated 30 August 2018.

The project focuses on the referral, waitlist and appointment booking processes of the Maitland Hospital Paediatric Ambulatory Care Service to deliver timely, efficient and effective care to children.

View a poster from the Centre for Healthcare Redesign graduation, August 2018.


Improve the efficiency and effectiveness of the Maitland Hospital Paediatric Ambulatory Care Service in the areas of referral and waitlist management by December 2018 to ensure patients have better access to safe and timely care.


  • Safe and timely access to the service through improved management of referrals, waitlists, and clinics.
  • Improved patient and staff satisfaction with a reduction in complaints and ministerial
  • Efficient use of health resources and standardised processes minimise non-attendance rates, and maximise revenue.


The Maitland Hospital is a Level 4 rural referral hospital based in the Hunter New England Local Health District. Planning is currently underway for a new Maitland Hospital to meet the Hunter’s growing health needs. Currently, Maitland has a higher proportion of youth (0-15 years) and families compared to the Hunter Region and NSW, with a 25% population growth rate predicted by 2036.

In April 2016, key stakeholders identified the following issues impacting the ability of the service to function effectively and efficiently.

  • No governance model or accountability
  • Limited reporting of activity data
  • No identified KPIs and reporting processes
  • No standardised waiting list data and management of waiting lists
  • No nursing or allied health personnel in the team

Complaints and ministerial identified children were waiting more than two years for an appointment. At the start of this project, 61% of children had been on the waitlist for more than 365 days and 32 children waited more than 1,000 days for an initial appointment. In addition,

  • 94% of referrals were not triaged within seven days
  • there was a back-log of referrals not entered into the waitlist system
  • children could not be offered an appointment time any further than 30 days in advance.

The service needed review and improvement to minimise the risk of adverse outcomes for children, reduce wait time to see a paediatrician, increase community engagement, meet future demand, and stem revenue loss.


Introduce electronic management of patient referrals and triaging

  • Administration staff completed a waitlist audit to remove duplicate referrals and children no longer needing to see a paediatrician.
  • All paper referrals were scanned into an electronic referral management system.
  • Referral management processes were developed and documented.
  • Staff training undertaken.

Allocate patient referrals and appointments to a dedicated person

  • Process mapping of tasks and duties performed by administration staff to identify areas for potential efficiencies.
  • Key performance indicators for administration staff developed and implemented.
  • Administration position descriptions updated.

Open up bookings to offer patients appointments up to 12 months in advance

  • Discussions were held with the Director of Paediatrics and Paediatricians to standardise clinic scheduling arrangements and open appointments 12 months in advance
  • An appointment booking template was developed and completed by the Paediatricians to assist administration staff in pre-populating schedules 12 months in advance in iPMs
  • Localised procedures documented for the opening and booking of appointments

Patients receive timely information about their referral and appointments along with the ability to confirm attendance

  • Patient letters and SMS content reviewed with stakeholders.
  • Feedback was provided to patient information systems regarding changes to the patient letters and SMS content.
  • Patient referral and appointment information was standardised.
  • A process for monitoring confirmation of appointments was implemented.


Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.


1 July 2017 – 31 December 2018

Implementation sites

The Maitland Hospital


  • Partnership, Innovation and Research Unit, Hunter New England Local Health District
  • Hunter Primary Care


The project will be formally evaluated in December 2018 to measure the following outcomes.

  • Number of non-triaged referrals waiting more than seven days
  • Number of urgent paediatric patients waiting more than 30 days for an initial appointment
  • Number of semi-urgent paediatric patients waiting more than 90 days for an initial appointment
  • Number of non-urgent paediatric patients waiting more than 365 days for an initial appointment
  • Number of referrals rejected
  • Percentage of available appointments booked and confirmed
  • Number of patient complaints recorded

Lessons learnt

  • Strong sponsorship at all levels (including reinforcing sponsorship) is vital.
  • Consumer engagement and patient stories help to guide and shape the project.
  • Whilst the diagnostic phase takes time, it is crucial to cover the breadth and depth of the issues to sufficiently inform the direction of the project.
  • Never underestimate the impact of workplace culture, individual readiness to change, the value of change agents, and implementation history.


Sharon Lawrence
Ambulatory Care Project officer (Project Team Member)
Allied Health, Community Health and Integrated Care
The Maitland Hospital
Hunter New England Local Health District
Phone: 0427 016 897

Jessica Crombie
Paediatric Unit Nurse Unit Manager (Project Team Member)
Paediatric Unit
The Maitland Hospital
Hunter New England Local Health District


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PaediatricEfficiencyHunter New EnglandOutpatientMetropolitanCentre for Healthcare Redesign
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