Commission on Excellence and Innovation in Health

Measuring emergency surgery demand versus capacity

27 Sept 2022

A key strate­gic ini­tia­tive of the Statewide Sur­gi­cal and Peri­op­er­a­tive Care Clin­i­cal Net­work (SSPC­CN), is to exam­ine emer­gency surgery wait times to deter­mine if there is a mis­match between demand and capac­i­ty, or evi­dence of peo­ple wait­ing longer for emer­gency surgery than clin­i­cal­ly planned. Addi­tion­al­ly, the size and mag­ni­tude of the prob­lem and its impacts on patient out­comes, was to be reviewed.

Although analy­ses have been occur­ring at the Local Health Net­works (LHN) lev­el, there has been no vis­i­bil­i­ty pre­vi­ous­ly across met­ro­pol­i­tan Ade­laide, where the major­i­ty of emer­gency surgery occurs, of the demand ver­sus capac­i­ty chal­lenges or any stan­dard­ised method for assessing. 

The CEIH worked with the LHNs to pro­duce for the first time, a stan­dard­ised data set to enable bench­mark­ing and con­sis­tent met­rics across met­ro­pol­i­tan pub­lic hos­pi­tals. Sur­gi­cal and Anaes­thet­ic Heads of Unit from each met­ro­pol­i­tan LHN, joined to form an Emer­gency Surgery Group to under­take this work. 

Data pro­vid­ed by The CEIH team showed for the peri­od that emer­gency the­atres are used, almost 35% of the time is the turn­around time between patients (effec­tive util­i­sa­tion 65%). 

Based on this pre­lim­i­nary analy­sis, it appears approx­i­mate­ly 35 beds per day are occu­pied by patients who have wait­ed more than 24 hours, in excess of the clin­i­cal­ly rec­om­mend­ed time, for their emer­gency surgery. There is a direct link to emer­gency depart­ment con­ges­tion and poten­tial­ly impact­ing those patients wait­ing, on the ramp’, in ambu­lances, to be able to access a bed in the emer­gency department.

Fol­low­ing ini­tial analy­sis, it was pro­posed that a Statewide Emer­gency Surgery sub-com­mit­tee be formed, under the aus­pices of the SSPC­CN. The sub-com­mit­tee will review and imple­ment rec­om­men­da­tions to improve emer­gency surgery capac­i­ty and pro­vi­sion, based on the find­ings with­in the Met­ro­pol­i­tan Oper­at­ing The­atre Emer­gency Surgery, Demand ver­sus Capac­i­ty’ analy­sis report. 

The com­mit­tee will also be charged with research­ing and for­mu­lat­ing fur­ther rec­om­men­da­tions to address the cur­rent mis­match between the capac­i­ty and demand for emergency.