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Access Improvement and Reform
Focus at Bendigo Health
At BH we undertook to focus on meeting
the timeframes for the referral
management process
Specialist Clinics at Bendigo Health
At Bendigo Health there are four separate
specialist clinic areas which fall under the
access policy:
Acute Medical/Surgical
Women’s Health
Allied Health
2,500 new referrals per months
Referral Processing Timelines
Referral Count
% Over Target
Referral Count
The graph shows percentage of referrals which exceeded the 8 day
timeframe. The grey line shows the number of referrals received and the red
line shows the % of those over the 8 day target in each specialty
% Referrals Over Target
Referral Performance
July - December 2013
Referral Processing
Initial Findings:
The baseline data revealed wild variation in timeframe targets from
specialty to specialty
Investigations into the reasons for the variations revealed the causes
to be inconsistencies in the data due to areas using different
databases to record referrals
Process mapping revealed the methods of processing referrals were
unique to each individual area because each area had developed
their processes independently. Indeed they varied from specialty to
The format and methods of correspondence with referrers and
patients in relation to referrals had also evolved separately in each
Action on Referrals
The players
We are working closely with each of the Specialist Clinic Managers from these areas
to ensure the consistencies we are striving for accommodate the unique needs of
the individual areas
The involvement of Surgeons and Physicians is seen as essential to secure
engagement in the objectives
Any redesign regarding referrals will have an impact on GPs. It was seen to be vital to
include a GP representative both to inform GPs of changes within the hospital and
to invite input in regard to GPs needs and capabilities.
IT and data managers are vital players in this improvement. Many of the anticipated
improvement will be achieved with the use of IT enablers. The data available to us
from our Performance Reporting Unit allows us to track our progress in regard to
our nominated milestones.
This all takes place in the context of the New Bendigo Hospital which is currently
under construction due for completion in 2016. In this arena models of care are
being reviewed across all areas of the organization. Essentially the management of
referrals constitutes one aspect of operational models of care. So representation
with this focus plays a vital role in this initiative.
Action on Referrals
Work required
From the outset, it became obvious that milestones could only be met through
consistency across the four areas. We needed to achieve consistency in data
capture & reporting; referral management processes; and correspondence.
Essentially there is universality in the objectives and the outcomes of care. The
differences lay in the processes used to get there and the quality of the data
available on the work being done.
Through the process mapping, delays/bottlenecks were identified in medical triage
and in some clerical processing. In order for the timeframes to be met for key
processes, with consideration to resource constraints, the clerical delays could be
addressed. With regard to triage, a decision was made to move towards referral
triage by nurses, midwives and allied health personnel. This would reduce a ninestep process to a four-step process
As this function was previously performed by consultant medical staff, there were no
written guidelines or criteria. The most time consuming task was the drafting of
these triage criteria and the approval process required to implement the use of
In the setting of moving towards a paper-light environment for the new hospital, there
is work underway towards an EMR. The capacity to receive referrals electronically
is related to this project.
Engagement of the stakeholders is the greatest challenge
As with any major change in processes, designing and planning the necessary
changes to meet the goals is the easy bit. Engagement with all
stakeholders is essential to ensure the success of implementation.
Firstly, the engagement of all four areas to work together towards the goals.
Secondly the engagement of staff within those areas to change their
Thirdly the engagement of consultants, many of whom are VMOs
Finally the engagement of IT, HIS, PRU to assist in the structures required to
support the changes.
Action on Referrals
Develop triage criteria to facilitate nurse-led triage
General Surgery, ENT, Antenatal – Pre-existing
Orthopaedics & Oncology - May 2014
Urology, Allied Health, & Gynaecology - July 2014
Cardiology, Renal, & Respiratory - October 2014
General Medicine - March 2015
Electronic referral project and electronic discharge
correspondence are being developed in conjunction with
the EMR
APAC 7 will enable the tracking of referrals returned to the
referrer for further information.
Additional Opportunities
Engagement of the Information Technology Department has
presented us with additional opportunities to make
improvements beyond the nominated milestones
We are developing an application in Sharepoint which provides
us with the ability to track and keep records of the waiting list
validation process.
Also with the use of Sharepoint, a database has been developed
to record clinic start times in a manner which allows us to
report easily on the results and trends.

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