Economic evaluation of the proposed surgical scheme at Auburn Hospital: Final report, CHERE Project Report No 19

Background Public hospitals have experienced budget constraints but as demand for admissions has been growing at the same time, occupancy levels have been increasing. As emergency and urgent admissions are given priority, the effect has been not just longer waiting times and larger waiting lists for non-urgent admissions, but also frequent cancellations of elective surgery, thus adding to patients? waiting time. Consequently, there have been a number of attempts to reduce elective surgical waiting lists. The Auburn Elective Surgical Program (AESP) was a pilot program funded by the NSW Health Department, to improve elective surgery for patients in Western Sydney Area Health Service (WSAHS). The program commenced 19th July 2001 and ended 15th November 2001. Initially, the program targeted three specific surgical procedures, laparoscopic cholecystectomy, hernia repair, and haemorrhoidectomy, and was expanded to include thyroidectomy, ligation and stripping of varicose veins and endoscopy. The program sought to improve the effectiveness and efficiency of administrative and clinical aspects of elective surgery by: > Using spare operating theatre capacity at Auburn Hospital; > the use of a new booking and waiting list system, managed by a nurse co-ordinator, which offered suitable patients a definite date for surgery; > increasing surgical sessions by paying participating surgeons on a fee for service basis; > however, surgery could be performed by a surgeon other than their treating surgeon; > re-structuring elective surgical sessions to eliminate meal breaks; > planning post discharge care so that surgery could be performed on a day only basis. The Centre for Health Economics Research and Evaluation (CHERE) was commissioned to undertake an independent evaluation of the AESP. This study has examined the throughput, health outcomes, costs and patient satisfaction. Throughput data on the program were defined as time spent on the waiting list, number of failures to attend planned surgery, average length of stay, and number of surgical interventions. Health consequences were defined as complications, unplanned readmissions to hospital, wound infection after surgery, mortality, percentage of same day admissions and conversion rate to open cholecystectomy. Costs were estimated from a health service perspective. Patient acceptability was assessed by the proportion of eligible patients having their surgery under the AESP, and patient satisfaction by questionnaire.