There are apparent inconsistencies in clinical urgency categorisation among the states and territories, so recent national reporting of comparable elective surgery waiting times data has not used the national data on clinical urgency category. Variation in the recording of waiting times for patients who are not ready for care, for example, for planned follow-up surgery, has also been apparent.
The Expert Panel established by governments to report on elective surgery and emergency access targets noted this variation in its report to the Council of Australian Governments (COAG) in July 2011. In this report, it recommended to COAG that, in order to develop consistent national elective surgery categories, the Australian Institute of Health and Welfare (AIHW) work with the Royal Australasian College of Surgeons (RACS) to, as a matter of urgency, develop national definitions for elective surgery categories, including not ready for care.
This report was submitted to the Standing Council on Health (SCoH) in December 2012 by the AIHW and the RACS in response to a request from the Council following the Expert Panel's recommendation.
It was informed by extensive advice and inputs from representatives of the Australian Government, state and territory health authorities, surgical specialty and other clinical stakeholder groups, and health consumer groups. It was also informed by comments from the Australian Health Ministers' Advisory Council and the Council of Australian Governments' Expert Panel for the Review of Elective Surgery and Emergency Access Targets.
The national elective surgery urgency category definitions package
The proposed approach to improve the consistency and comparability of elective surgery urgency categories comprises a package of six integrated components:
- A statement of an overarching principle for urgency category assignment:
- Patients who require an elective procedure should be assigned an urgency category by the treating clinician. The urgency category should be:
- Appropriate to the patient and their clinical situation
- Not influenced by the availability of hospital or surgeon resources.
- Simplified, time-based urgency category definitions.
- A listing of the usual urgency categories for higher volume procedures, to be developed by surgical specialty groups.
- Comparative information disseminated about urgency categorisation.
- 'Treat in turn' as a principle for elective surgery management.
- Clarified approaches for patients who are not ready for surgery, because of clinical or personal reasons.