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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE (Open Access)

Using an under-utilised rural hospital to reduce surgical waiting lists

Tracey Edwards A # , Andrea Boerkamp A B # , Kimberley J. Davis https://orcid.org/0000-0002-7835-7259 A C and Steven Craig https://orcid.org/0000-0001-6403-7863 A B *
+ Author Affiliations
- Author Affiliations

A Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Keiraville, NSW 2522, Australia.

B Department of Surgery, Shoalhaven District Memorial Hospital, Illawarra Shoalhaven Local Health District, Scenic Drive, Nowra, NSW 2541, Australia.

C Research Operations, Illawarra Shoalhaven Local Health District, NSW, Australia.

* Correspondence to: steven@drstevencraig.com.au
# These authors contributed equally to this paper

Australian Health Review 48(3) 248-253 https://doi.org/10.1071/AH23191
Submitted: 28 September 2023  Accepted: 8 March 2024  Published: 25 March 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Objectives

This study aimed to evaluate patient outcomes from a 12-month pilot program establishing specialist surgical services in a small rural (Modified Monash Model, MM4) hospital on the south coast of NSW.

Methods

Suitable patients for ambulatory surgery were selected based on strict anaesthetic, surgical and social criteria. Skills shortfalls among nursing staff, usually with emergency or inpatient experience, were addressed by appropriate re-training and in-service training in scrub, scout and anaesthetic duties. An anonymous post-operative patient survey was administered during the pilot program, which assessed patient experiences and outcomes. Of 162 patients undergoing surgery during the pilot, 50 consecutive participants completed the survey.

Results

Of the 161 procedures during the pilot program, 100 were performed under sedation and locoregional anaesthesia and 62 under general anaesthesia. Half (n = 86, 53.4%) were complex excisions of malignant skin lesions, and of these 63% also required either a skin graft or local flap repair. Survey respondents reported adequate information and pain relief upon discharge (n = 45, 96%) and 100% were satisfied with the care received. No respondents needed to see a doctor following discharge. There were no mortality events or major issues of morbidity during the study period or subsequently, no further overnight admissions or return to theatre and no re-presentations within 48 h of operating. Two superficial surgical site infections were reported.

Conclusions

There is merit in drawing on underutilised resources in small rural hospitals in support of initiatives to reduce surgical waitlists. Appropriate outpatient surgeries can be safely performed with high levels of patient satisfaction.

Keywords: elective surgery, health services administration, patient satisfaction, rural health, rural health services, rural hospitals, rural surgery, waiting lists.

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