• Judy A Lowthian, Andrea J Curtis, Bernadette L Comitti, Peter A Cameron, Martin J Keogh, William R Johnson, James Tomlinson, and Andrew M Stripp.
• 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
• Med. J. Aust. 2011 May 2;194(9):448-51.

ObjectiveTo evaluate the effectiveness of redesigning and streamlining perioperative services.DesignA before-and-after evaluation, with retrospective analysis of de-identified administrative data.SettingA major tertiary hospital, Melbourne, Australia.ParticipantsPatients undergoing elective surgery, February 2005 - February 2010.InterventionImplementing 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 MeasuresNumbers 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.ResultsThe 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).ConclusionsClinical 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.

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