title: Streamlining elective surgery care in a public hospital: the Alfred experience.
abstract: OBJECTIVE
  To evaluate the effectiveness of redesigning and streamlining perioperative services.
  
  
  METHODS
  A before-and-after evaluation, with retrospective analysis of de-identified administrative data.
  
  
  METHODS
  A major tertiary hospital, Melbourne, Australia.
  
  
  METHODS
  Patients undergoing elective surgery, February 2005 - February 2010.
  
  
  METHODS
  Implementing a process redesign to streamline clinical pathways for elective surgery, with a focus on the patient journey from referral to discharge, and establishing a separate, dedicated elective surgery facility.
  
  
  METHODS
  Numbers of patients waiting beyond national recommended waiting times for elective surgery; hospital-initiated postponement (HIP) rates for elective surgery; and lengths of stay (LOS), both combined and for specific diagnostic-related groups.
  
  
  RESULTS
  The clinical process redesign resulted in a sustained downward trend in the number of elective surgery patients waiting longer than national recommended maximum waiting times. HIP rates were reduced to 1% in the dedicated elective surgery facility, and there was a significant reduction in the combined LOS, as well as the LOS for the most common surgical procedures (P < 0.001).
  
  
  CONCLUSIONS
  Clinical process redesign of perioperative services and collocation of a separate elective surgery centre improved (i) timeliness of care for elective surgery patients and (ii) key indicators (LOS and HIP rates) for planned elective admissions.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Centre of Research Excellence in Patient Safety, Monash University Melbourne, VIC. Andrew.Stripp@alfred.org.au
authors.forename: Judy A
authors.initials: JA
authors.lastname: Lowthian
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Curtis
authors.forename: Bernadette L
authors.initials: BL
authors.lastname: Comitti
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Keogh
authors.forename: William R
authors.initials: WR
authors.lastname: Johnson
authors.forename: James
authors.initials: J
authors.lastname: Tomlinson
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Stripp
mesh_terms: D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D019990:Perioperative Care / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000458:organization & administration; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology; D014850:Waiting Lists