Improving Efficiencies in Access to care and Patient flow in Scheduled Care in a Level 4 Academic Hospital

2019-11-22T18:07:23Z (GMT) by Josephine Ryan


Advancing the schema to reduce waiting times and shortening length of stay requires fundamental changes to current practice in healthcare with an emphasis on treatment that is efficient, effective and high quality. The Health Service Executive launched its 'Model of Care for Pre-asessment Units' (2014) as a guide for organisations to implement pre-admission units locally and facilitate pre-assessment as an out-patient service. This model was designed to be used in collaboration with the 'Model of Care for Elective Surgery' (2012) which promoted Day of Surgery Admission (DOSA) and improved access to scheduled beds. Within the writer's organisaton, Day of surgery admissions were reaching the national target of 75% despite an inefficient use of the pre-assessment clinic with only 20% of patients pre-assessed prior to DOSA. Furthermore, a total of 28 patients were breaching over 15 months for routine surgical procedure.


To enure that:

  • 80% of schedules patients were pre-assessed prior to DOSA
  • To ensure access for routine surgical patients who are currently breeching national waiting times of 15 months by end of December 2015 ...


HSE Change Model was used for the Implemations of this project and the CIPP (Context, Input, Process and Production) evaluation model was used for the elevation of data.


Pre-assessment rates have risen from 20% prior to implementation of the project to 80% within a 17 week period. All 28 patients breeching the 15 month waiting time has their surgery completed by end of December 2015.


Ritualistic practices have been weaned out and replaced with this new process. Organisationally there is evidence of a collaborative approach, maintaining momentum for this change and a staff nurse on the day ward is the change champion for this project.