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Section A - Policy
8. Access
8.1 Hospital Access Program
Access to elective surgery, emergency and critical care services is essential to the operation of an effective health system. The provision of funding through the Hospital Access Program (HAP) is an incentive for Health Care Networks and hospitals to improve patient access to these services. For details on the Hospital Access Program refer to appendix 4.
- The indicator for Category 1 patients has been retained with all patients expected to be treated within 30 days;
- For Category 2 patients, the approach based on continuous reduction in waiting list numbers has been replaced with an indicator which measures the proportion of Category 2 patients treated within the clinically appropriate time frame of 90 days; and
- Indicators for the average and median waiting time of Category 2 and Category 3 patients waiting for surgery have been introduced.
8.1.1 Emergency Services
In 1998 - 99 there were substantial changes to the admission block indicator. Benchmarking was introduced, blocked admissions were measured as a proportion of admissions to ward and quarterly variations in targets were sought to take account of seasonal demand pressures. Central electronic collection of the Victorian Emergency Minimum Dataset (VEMD) began and hospitals and the Department put substantial effort into data quality including reconciling electronic with paper based aggregate data, in preparation for phasing out paper based reporting. Bonus payment will be tied to the submission of timely and accurate data in 1999-2000.
The consistency of measurement of admission block across hospitals is being examined and a project to improve consistency in triage categorisation is underway. No major change in approach to these areas is proposed for 1999 - 2000.
Attention will continue to be given to data accuracy and consistency of categorisation and measurement. The availability of patient level data will enable exploration of a number of potential indicators of interest to hospitals and the Department including waiting times for patients who are not seen within target times. In 2000 - 2001, the target for the percentage of triage category 2 patients treated within ACEM recommended timeframes will be increased. In addition, targets for Category 4 and 5 patients will be introduced.
8.1.2 Critical Care
Indicators for critical care inter-hospital transfers were introduced in 1998 - 99. To date, this new component of the access program appears to be working well in maximising critical care bed availability for presenting patients. Considerable work has been undertaken by hospitals and the Department on data systems and quality. Some further work is required for definitive reporting.
Further policy work on critical care bed availability will be undertaken in 1999-2000. Preliminary work on benchmarking will be undertaken. Two policy initiatives were introduced in 1998 - 99 to improve bed availability - the critical care patient transfer indicators included in HAP and the provision of funding to metropolitan Health Care Networks/hospitals for the purchase of private critical care when no public bed is available. The combined effect of these initiatives will be examined to determine whether refinements to the program are desirable. The Department will continue to work with the Critical Care Transfer Monitoring and Advisory Group and hospitals on this component of the Hospital Access Program.
8.1.3 Elective Surgery
The independent Review of Elective Surgery Waiting Lists, under the chairmanship of Dr Bernard Clarke, was asked to examine whether the system of giving incentives to hospitals to provide priority for those most in need of care resulted in appropriate management and clinical behaviour. The Review Panel published its findings in September 1998 and recommended that incentives to encourage hospitals to achieve waiting list reductions through good management should be maintained and enhanced, and that waiting lists targets should be reviewed and restructured to adequately recognise increased surgical work load, high quality of care and anticipated further increases in demand.
New elective surgery performance indicators and targets were introduced in April 1999, following consultation with the Advisory Committee on Access to Elective Surgery (ACAES), Health Care Networks and hospitals:
For 1999-2000 the median waiting time will no longer be used to calculate bonus payments. An indicator on the size of the waiting list will be reintroduced and the effects of the indicators and targets will be monitored. In addition, Elective Surgery Information System (ESIS) data will be used to examine and report on an increasing range of elective surgery issues over time.
Major effort by hospitals and the Department has led to improvement in the quality of ESIS data over the past 12 months. The Review of Elective Surgery Waiting Lists strongly recommended the need for accurate ESIS data, supporting ongoing refinement of this system and rigorous verification of data accuracy. Data quality improvement will continue with the introduction of the revised ESIS on 1 July 1999. As part of efforts to improve data quality, the revised ESIS has a list of edits, or reasons for a patient record to be rejected or flagged. Bonus payments will be linked to these and to the timeliness of data submissions.
Following the recommendation of the Review of Elective surgery Waiting Lists that the current system of categorising patients according to clinical urgency category should be retained and that clinical guidelines for the categorisation of patients in each specialty area should be developed by the Royal Australasian College of Surgeons (Victorian State Committee), the Department is funding the College to start this project in the 1999-2000 financial year. The project will run over a period of 12 months and is expected to deliver guidelines for use in all specialty areas.
8.1.4 Service Improvement Initiative
This financial year a minimum of 10 per cent of total HAP bonus funds allocated to participating Health Care Network/hospital will be expected to be spent on specified projects or initiatives to enhance patient access to elective surgery, emergency and critical care services. Projects may focus on one or more of the individual areas of elective surgery, emergency and critical care services or take an integrated approach to enhancing access across the three areas. Networks and hospitals will be required to provide details of their intended use of these funds by 1 November 1999 and these details will be made available to relevant committees.
A review of neonatal services was carried out in 1998 - 99 resulting in a number of recommendations designed to improve the capacity and integration of neonatal services in Victoria. The report of the review has been distributed to all public hospitals and to interested groups and individuals.
Additional funding of $2 million has been allocated for neonatal services in 1999 - 2000. Most of this funding will be distributed in the form of growth WIES to those hospitals highlighted as in need of additional funding. These hospitals will be expected to fulfil specific conditions of funding for these allocations.
Additional funding will be provided to the Newborn Emergency Transfer Service (NETS) to contribute to the cost of medical retrievalists. In the past, these costs have been borne by the retrieving hospitals.
A review of the neonatal funding model has begun. The results of this review will be considered next financial year. Progressive consideration and implementation of the remainder of the review’s recommendations will occur during 1999 - 2000 in consultation with hospitals and Health Care Networks and other interested parties.
Funding of $1.8 million has been allocated to purchase neonatal equipment. A proportion of this will be allocated to selected hospitals receiving neonatal growth funding. The remainder will be subject to a targetted submission process.
8.3.1 Chest Pain Evaluation Areas
The Department has provided funding for Monash Medical Centre, the Royal Melbourne Hospital and the Alfred to pilot Chest Pain Evaluation Areas for an eighteen month period. These are dedicated areas within or adjacent to emergency departments in which selected patients are systematically evaluated for the potential for heart attack or angina. Chest Pain Evaluation Areas in other parts of the world have been shown to improve patient assessment resulting in improved clinical outcomes and more efficient use of hospital resources. The cost benefit of the pilots will be evaluated early in 2000 - 2001.
8.3.2 Health Information and Referral Telephone Service
The Department will tender a 24 hour Health Information and Referral Telephone Service aimed at improving the integration, consumer orientation and appropriate targeting of service delivery. A joint initiative of the Aged, Community and Mental Health and Acute Divisions, this service will provide a nurse triage service to respond to and appropriately refer calls from the public, as well as provide information on, and referral to, the primary health and community support system. The new service will provide a valuable supplement to the existing service system and is expected to reduce pressure on emergency departments with respect to less urgent patients.