Elective surgery improvement initiatives

The elective surgery improvement plan aims to:

• improve patient outcomes and experiences of care
• optimise resource allocation
• improve staff experience in care delivery.

In partnership with the NSW Ministry of Health and the Surgical Care Network, the ACI is continuing to develop evidence-based guidance, tools and resources to support clinicians and health services improve elective surgery in NSW.

There are four key initiatives driving these improvements: value-based surgery; enhanced recovery after surgery (ERAS); prehabilitation; and same-day joint replacement surgery.

Value-based surgery

Value-based healthcare involves matching and maximising the benefits of health resources to evidence-based outcomes, best practice and personalised patient outcomes, that are aligned with the patient’s preferences.

This means patients will have the right procedures, for the right reasons, at the right time.

• Value-based elective surgery: audit indicators (PDF 514.7 KB)
  Promote value-based clinical and operational decisions for hysterectomy; tonsillectomy (outside accepted criteria) and myringotomy with or without grommets (outside accepted criteria).
  Published: February 2024. Next review: 2029.
• Value-based surgical care: Defining key indicators (PDF 431.3 KB)
  Use these indicators to consider clinical justifications, individual risks, benefits of surgical procedures, health outcomes and patient experiences.
  Published: September 2022. Next review 2027.
• Value-based surgery: Clinical practice guide (PDF 767.0 KB)
  Review which procedures are clinically appropriate for your hospital.
  Published: November 2023. Next review 2027.

Enhanced recovery after surgery

Enhanced recovery after surgery (ERAS) models are multi-modal perioperative care pathways. They are designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery.

• Enhanced recovery after surgery: key principles for implementation of models (PDF 288.6 KB)
  These principles underline the implementation of enhanced recovery after surgery (ERAS) models to improve patient engagement in their recovery, reduce length of hospital stay and enhance use of health resources.
  Published April 2023. Next review 2028.
• Enhanced recovery after surgery: key principles for colorectal surgery, elective surgery action plan (PDF 216.8 KB)
  Create an action plan for colorectal surgery using these principles, implementation enablers and interventions.
  Published: July 2022. Next review: 2027.
• Enhanced recovery after surgery for colorectal surgery: Audit and feedback guide (PDF 411.0 KB)
  Measure your service against the key principles for colorectal surgery.
  Published: August 2022. Next review: 2027.
• Local case study: Enhancing outcomes for breast surgery: mastectomy and wide local excisions
  Review the experience of Hunter New England Health’s implementation of ERAS.
  Published: September 2022. Next review 2027.

• Local case study - Enhancing outcomes for orthopaedic surgery: elective knee and hip replacement surgery
  A rural hospital in NSW applies ERAS protocols to improve outcomes for patients after knee and hip replacement surgery.
  Published: April 2023. Next review 2028.
• Local case study - Enhancing outcomes for colorectal surgery to implement ERAS for upper gastrointestinal urology and vascular procedures
  The ERAS initiative at St George Hospital leads to improved outcomes, such as reduced length of hospital stay, for patients undergoing colorectal surgery and upper gastrointestinal urology and vascular procedures.
  Published: April 2023. Next review 2028.

Prehabilitation

Prehabilitation improves a patient’s physical and psychological function to support them before, during and after surgery. This can lead to a faster recovery, better patient experiences and cost savings for the health system.

• Prehabilitation: Key principles for preparing patients for surgery (PDF 620.0 KB)
  Promote healthy behaviours by prescribing of exercise, nutrition, education and psychological interventions before surgery.
  Published: September 2022. Next review: 2027.
• Case studies of existing prehabilitation sites in NSW (PDF 431.5 KB)
  Learn how prehabilitation is currently working.
  Published: August 2022. Next review: 2027.

Same-day joint replacement

Same-day joint replacement surgery provides an opportunity for an alternative care pathway for patients accessing joint replacement surgery across NSW. It enables the patient to be discharged within 24 hours of their surgical admission.

• Same-day hip and knee joint replacement surgery key principles (PDF 280.0 KB)
  Use these principles and enablers to implement same-day surgery.
  Published: March 2022. Next review: 2027.
• Same-day joint replacement surgery evidence check (PDF 301.4 KB)
  Consider the evidence behind the principles.
  Published: November 2021. Next review: 2027.

Background

Elective, or planned, surgery is scheduled in advance of a patient presenting to hospital. It can be categorised as urgent, semi-urgent or non-urgent.

The ACI’s Surgery and Anaesthesia team supports enhanced access and outcomes of elective surgery by:

• identifying and sharing innovative organisational models
• developing evidence-informed clinical guides to encourage best practice surgical care
• developing tools to assess and monitor surgical outcomes
• creating strategies and resources to support implementation of improvement initiatives
• connecting clinicians and health managers with an interest in surgery to build collaborative relationships across the health system.

Find out more about the Surgical Care Network and the Anaesthesia Perioperative Care Network.