Dr Sharon Monagle
Statewide Elective Surgery Reference Group
18 May 2005.

The agenda for this meeting was focussed on the discussion of 2 themes:

1. Defining the patient i.e. clarifying who will be treated at the Alfred Centre.

• Current Alfred Hospital work (80% of current elective surgery at the Alfred would be performed at the Alfred Centre).  This would amount to approx 5600 separations per year. The Alfred Centre model would allow for this group to be managed within a shorter LOS than can occur at the Alfred Hospital
• New capacity (of around 3,500 separations per year). This would be made up by:
  o Alfred Waiting list priority patients
  o Patients from the secondary catchment area, i.e. targeting the long waiting patients from other metropolitan hospitals
  o Elective Surgery Access Scheme (ESAS): targeting long waiting patients from across the state

The Alfred Centre will have 4 operating theatres and will also have cath labs and endoscopy suites.  The mix of patients treated will be as above, although proportions from each group are yet to be determined.

2. Referral and Assessment
Referral pathways are likely to vary according to clinical conditions and will be protocol/pathway driven (as above). Condition A might be amenable to direct referral to the Alfred Centre Patient Service Centre (PSC), whereas Condition B might require some intervening step.  The PSC will be a key feature of the Centre, providing a unique set of functions to facilitate patient low and readiness for surgery.  Preadmission Clinics are also set to be redesigned, with the aim of assessing patients within a very short time of their surgery.

Referral protocols are likely to be developed from early work being done at the Alfred outpatients, whereby referring doctors are given very clear guidelines re how and when to refer, how to determine urgency, and realistic information about a patient's likelihood of being seen.

Content of meeting of interest to Divisions/GPs/GPDV Board:
Of particular interest is the very clear intention from DHS and the Minister that we are moving towards a state-wide referral and service system for elective surgery.  This has already begun through the ESAS project and is set to expand and potentially replace the existing model (of having elective surgery performed at your local hospital).  DHS sees this as the way forward to reduce waiting lists (such that all patients have their surgery within expected timeframes), to manage the workforce constraints that we face, and to maintain viable surgical centres outside the metro area (i.e. by increasing surgical throughput in areas where capacity currently exists).

Next SESRG meeting: 15 June 2005