Victoria - Public Hospitals Policy and Funding Guidelines 1997-1998
Section A: Policy

5.0 Emergency Services and Elective Surgery Enhancement Programs

Waiting lists for elective surgery; occasions of ambulance bypass; and waiting times for triage and admission within emergency departments are indicators of access, timeliness, and quality of health care in Victorian hospitals. The provision of funding through the Enhancement Programs is an incentive for Networks and individual hospital campuses to improve measurable performance in these areas.

In 1997-98, the Programs will place emphasis on an integrated approach by Network/hospital management to the Elective Surgery and Emergency Services Enhancement Programs within hospital campuses. Targets and penalties have been refined to ensure continuous improvement, with a particular focus given to those areas where insufficient improvement has been achieved to date. Specific projects will also be funded to further underpin improvement. Details of the total program are given in appendix 3.

5.1 Elective Surgery Enhancement Program

Since 1994-95, this Enhancement Program has achieved a dramatic reduction in patients waiting longer than is clinically desirable for elective surgery, particularly in urgent and semi-urgent categories, through the provision of incentive funding to those hospital campuses which have achieved targeted reductions in the numbers of patients waiting.

In 1997-98 the Program will be expanded and operate with a budget of $17 million. Major changes to the Program include the allocation of funds on the basis of volume and complexity; bonuses for reductions in postponements of surgery; increased emphasis on consumers; and incentives to encourage cross-service planning and management. While targets remain consistent with those for 1996-97, from 1 January 1998, an important change will be implemented in that the performance criteria for Category 1 and Category 2 patients will be expanded to include patients on booking lists. (The total number of hospitals in this Program is currently under review and may marginally affect the total budget figures).

An important aspect of the Program's refinement will be the implementation of the Elective Surgery Information System (ESIS) in 1997-98. This will provide more detailed information on patient characteristics and actual waiting times. This will enable increased emphasis on equity of access, including a reduction of hospital initiated admission postponements. Actual waiting times for all patients and waiting times for particular procedures will be examined more closely once ESIS information becomes available and will be a consideration in future funding programs.

In addition, projects to improve consumer information and to promote greater consistency of clinical urgency categorisation will be conducted in 1997-98.

5.2 Emergency Services Enhancement Program

This Program, which commenced in 1994-95, has achieved significant and continued improvement in access and timeliness of patient treatment in hospital emergency departments.

In recognition of its success, the Program will operate in 1997-98 with an increased budget of $17 million. It is expected that additional resources will enable greater attention to the reduction of admission block. In addition, triage targets for Categories 2 and 3 patients have been increased in line with the Program's continuous improvement approach. While the target for ambulance bypass remains constant, the bonus recall for failure to meet this target has risen. Along with the Elective Surgery Enhancement Program, this Program will contribute to additional incentives to promote an integrated approach to hospital emergency and elective services.

The Victorian Emergency Minimum Dataset is an essential tool for the implementation of ESEP and for the broader monitoring of the operation of emergency departments. The Emergency Departments Information Systems Steering Committee has recently reviewed Version 1 of the VEMD manual and incorporated many of the design and specification changes recommended by the user group. VEMD Version 2.0 will be implemented on 1 July 1997.

In addition, recalled funds may be allocated to specific projects such as specialist staff and equipment, more sophisticated information technology systems and more effective management and referral of patient groups with particular needs presenting to emergency departments.

5.3 Cross Program Management Bonus

A new bonus with a budget of $2 million ($1 million drawn from each of the Emergency Services and Elective Surgery Enhancement Programs) will be introduced in 1997-98 to promote an integrated approach to the delivery of timely, high-quality emergency and elective services within hospitals. Eligibility for the bonus will depend on achievement of 75 per cent of bonus payments in both emergency and elective enhancement programs in participating hospitals.

5.4 Intensive Care Enhancement Program

Enhancement funding of $275,000 will be available to Networks/hospitals in 1997-98, to facilitate the provision of intensive care patient level data to a minimum dataset. Funding will contribute to the system's establishment and ongoing operation. Planning of the dataset, data system and data usage is underway, involving the Department, the Australian & New Zealand and Intensive Care Society and the sector. Implementation will follow the resolution of data collection and management issues.

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Victoria - Public Hospitals
Policy and Funding Guidelines
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