Streamlining elective surgery care in a public hospital: the Alfred experience.

OBJECTIVE: To evaluate the effectiveness of redesigning and streamlining perioperative services. DESIGN: A before-and-after evaluation, with retrospective analysis of de-identified administrative data. SETTING: A major tertiary hospital, Melbourne, Australia. PARTICIPANTS: Patients undergoing elective surgery, February 2005 - February 2010. INTERVENTION: 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. MAIN OUTCOME MEASURES: 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.