![Page 1: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/1.jpg)
Achieving national elective surgery targets
(NEST) in Victoria
Professor Daryl Williams
Divisional director surgery, perioperative, trauma & surgical oncology,
Royal Melbourne Hospital
![Page 2: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/2.jpg)
Talk overview • NEST targets and categorisation • Referral, waitlists • Optimisation of patients • Streaming and elective/emergency mix • Models of care • Scheduling and queuing theory • Optimal theatre efficiency • Discharge planning • Future trends
![Page 3: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/3.jpg)
Talk overview
• NEST targets and categorisation • Referral, waitlists • Optimisation of patients • Streaming and elective/emergency mix • Models of care • Scheduling and queuing theory • Optimal theatre efficiency • Discharge planning • Future trends
![Page 4: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/4.jpg)
National Elective Surgery Target
NEST is divided into two complementary strategies:
Part 1: Stepped improvement in the number of patients treated within the clinically recommended time.
Part 2: A progressive reduction in the number of patients who are overdue for surgery beyond the clinically recommended time.
*Na$onal Partnership Agreement (NPA) on Improving Public Hospital Services, pg 14 -‐ 26 hCp://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/npa-‐improvingpublichospitals-‐agreement
![Page 5: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/5.jpg)
NEST Part 1
Time Cat 1 Target Cat 2 Target Cat 3 Target
Baseline 92.3% 86.6% 89.4%
By Dec 2012 96% 90% 92%
By Dec 2013 100% 93% 95%
By Dec 2014 100% 97% 97%
By Dec 2015 100% 100% 100%
By 2015 100% of patients waiting for elective surgery will be treated within their clinical recommended time.
![Page 6: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/6.jpg)
NEST Part 2
Cat 31 Dec 10 (Baseline)
31 Dec 12 (Target)
31 Dec 13 (Target)
31 Dec 14 (Target)
31 Dec 15 (Target)
1 0 days 0 days 0 days 0 days 0 days
2 39 days 29 days 20 days 10 days 0 days
3 130 days 98 days 65 days 33 days 0 days
By 2015 the average overdue wait time will be zero days
![Page 7: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/7.jpg)
Total numbers of additions & removals from ES waitlist
![Page 8: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/8.jpg)
Median wait time to surgery in public hospitals 2010-11
![Page 9: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/9.jpg)
Variation in clinical urgency categorisation 2010/11
![Page 10: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/10.jpg)
Australian data for hip replacement
![Page 11: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/11.jpg)
Australian admission data
![Page 12: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/12.jpg)
Current categories for elective surgery
Source: The Australian Ins$tute of Health and Welfare (AIHW) (2008) Na$onal Health Data Dic$onary no. 14,
Na#onal Benchmarks. Urgency with which the pa$ent requires elec$ve hospital care/surgery
Surgical Category DescripBon of recommended Bmeframes Category 1 admission within 30 days desirable for a condi$on that has the poten$al to deteriorate
quickly to the point that it may become an emergency Category 2 admission within 90 days desirable for a condi$on causing some pain, dysfunc$on or
disability but which is not likely to deteriorate quickly or become an emergency
Category 3 admission at some $me in the future acceptable for a condi$on causing minimal or no
pain, dysfunc$on or disability, which is unlikely to deteriorate quickly and which does not have the poten$al to become an emergency.
![Page 13: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/13.jpg)
![Page 14: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/14.jpg)
National definitions for categorisation
![Page 15: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/15.jpg)
National Categorisation Overarching principle
Patients who require an elective procedure are assigned an urgency category by the treating clinician Appropriate to patient and their clinical condition Not influenced by availability of hospital/doctors
![Page 16: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/16.jpg)
Multifaceted approach to meet targets
![Page 17: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/17.jpg)
Talk overview • NEST targets and categorisation • Referral, waitlists • Optimisation of patients • Streaming and elective/emergency mix • Models of care • Scheduling and queuing theory • Optimal theatre efficiency • Discharge planning • Future trends
![Page 18: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/18.jpg)
![Page 19: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/19.jpg)
Referral Management
Electronic Standardised Appropriate for public hospitals Acceptance based on the capacity to treat in
a timely fashion
![Page 20: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/20.jpg)
Waitlists
![Page 21: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/21.jpg)
Talk overview • NEST targets and categorisation • Referral, waitlists • Optimisation of patients • Streaming and elective/emergency mix • Models of care • Scheduling and queuing theory • Optimal theatre efficiency • Discharge planning • Future trends
![Page 22: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/22.jpg)
Optimising Health
General preventative strategies
Targeted initiatives
Improved cardiorespiratory capacity
![Page 23: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/23.jpg)
TKR and Pre-habilitation
• Pre-operative muscle exercise program may improve outcome – resistance training, flexibility, step
training – 3x week, 8 weeks – improved strength, functional
outcomes at 1 and 3 months » Swank A. J Strength Cond Res 2011;
25: 318
![Page 24: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/24.jpg)
Talk overview • NEST targets and categorisation • Referral, waitlists • Optimisation of patients • Streaming and elective/emergency mix • Models of care • Scheduling and queuing theory • Optimal theatre efficiency • Discharge planning • Future trends
![Page 25: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/25.jpg)
Emergency Surgery trends Victoria
![Page 26: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/26.jpg)
Surgical caseload 2008-2011
![Page 27: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/27.jpg)
Who does emergency surgery?
![Page 28: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/28.jpg)
Elective – emergency mix
![Page 29: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/29.jpg)
Outcomes of EGS model Direct clinical effects
Decreased night time operating Reduced length of stay Decreased complication rates Lower return to theatre rates
Staff Improved satisfaction of surgeons Improved training of registrars
Electives Lower elective surgery cancellation rates Maintenance of elective surgery numbers
Cost neutral
![Page 30: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/30.jpg)
RMH demand profile
![Page 31: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/31.jpg)
70% can wait longer than 8 hours
![Page 32: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/32.jpg)
Emergency surgery demand & supply
![Page 33: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/33.jpg)
Timeliness of Emergency Surgery
![Page 34: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/34.jpg)
![Page 35: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/35.jpg)
Talk overview • NEST targets and categorisation • Referral, waitlists • Optimisation of patients • Streaming and elective/emergency mix • Models of care • Scheduling and queuing theory • Optimal theatre efficiency • Discharge planning • Future trends
![Page 36: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/36.jpg)
Queues
![Page 37: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/37.jpg)
Treat in turn
![Page 38: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/38.jpg)
Scheduling using Patient Flow Portals
![Page 39: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/39.jpg)
Variation
![Page 40: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/40.jpg)
Variation
![Page 41: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/41.jpg)
Variation
![Page 42: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/42.jpg)
Variation
![Page 43: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/43.jpg)
Care Bundles and Enhanced Recovery After Surgery (ERAS)
Care bundles are groupings of practice processes that individually improve care, but when applied together result in a substantially greater improvement.
![Page 44: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/44.jpg)
Colorectal ERAS
![Page 45: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/45.jpg)
Orthopaedic Joint ERAS
Malviya A. Acta Orthopedica 2011; 82: 577
![Page 46: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/46.jpg)
ERAS outcomes Lowered LOS Less complications ?Decreased Mortality
4500 consecutive joint replacements
reduced 90 day mortality: 0.8% to 0.2%
reduced LOS: mean 6 to 3 days less transfusion: 23% to 10% less complications
Malviya A. Acta Orthopedica 2011; 82: 577
![Page 47: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/47.jpg)
Checklists
A simple memory aid to ensure processes of care are completed
Example safe surgery saves lives
![Page 48: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/48.jpg)
Safe Surgery Checklist • 3 principles: "
Simplicity " Wide applicability " Measurability "
Process " literature review" consensus among experts" wide consultation" piloting and evaluation"
![Page 49: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/49.jpg)
Results: Death & Complications
Change in Complications
Change in Death
High Income 10.3% -> 7.1%* 0.9% -> 0.6%
Low and Middle Income
11.7% -> 6.8%* 2.1% -> 1.0%*
* p<0.05 Haynes et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine
360:491-9. (2009)
![Page 50: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/50.jpg)
Talk overview • NEST targets and categorisation • Referral, waitlists • Optimisation of patients • Streaming and elective/emergency mix • Models of care • Scheduling and queuing theory • Optimal theatre efficiency • Discharge planning • Future trends
![Page 51: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/51.jpg)
Perioperative patient flows • Patient Streams
– Day case versus multiday – Hubs of specialisation – Flexible environments
• Stratification systems – Suitability for pathways – Perioperative Risk Stratification
• Efficiency Benchmarking – Real time tracking
![Page 52: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/52.jpg)
On the day
Start Time Matrix
3 key constraints – theatres, PACU, beds
Transparency of processes and flow Real time tracking of patients with automated alerts ERAS, standardised pathways and bundles
![Page 53: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/53.jpg)
Start time matrix
![Page 54: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/54.jpg)
Start time matrix
![Page 55: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/55.jpg)
Electronic Patient Calling Systems
![Page 56: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/56.jpg)
![Page 57: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/57.jpg)
Wireless Patient Tracking
![Page 58: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/58.jpg)
Electronic records & decision support
![Page 59: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/59.jpg)
Traffic light filtering systems
![Page 60: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/60.jpg)
Parallel Processing
![Page 61: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/61.jpg)
PACU block
![Page 62: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/62.jpg)
Theatre View
![Page 63: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/63.jpg)
Dashboards
![Page 64: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/64.jpg)
Talk overview • NEST targets and categorisation • Referral, waitlists • Optimisation of patients • Streaming and elective/emergency mix • Models of care • Scheduling and queuing theory • Optimal theatre efficiency • Discharge planning • Future trends
![Page 65: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/65.jpg)
Discharge Strategies
Rigorous discharge planning
Patient Flow Management Tool
Criterion based, nurse initiated discharge
![Page 66: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/66.jpg)
Talk overview • NEST targets and categorisation • Referral, waitlists • Optimisation of patients • Streaming and elective/emergency mix • Models of care • Scheduling and queuing theory • Optimal theatre efficiency • Discharge planning • Future trends
![Page 67: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/67.jpg)
Balancing public and private
Public
Swingers
Private
Private insurance hospital cover percentages June 1999: 30.6%
Introduction of 30% private health insurance rebate June 2011: 45.3%
![Page 68: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/68.jpg)
Australian elective & emergency surgeries in public and private
4.1% per annum increase in private elective surgery
![Page 69: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/69.jpg)
A decreasing queue discourages private insurance
If waiting times are diminished in public then private rates may decrease Private
Swingers
Public
![Page 70: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/70.jpg)
Victorian patients waiting >365 days for surgery
![Page 71: Daryl Williams, Melbourne Health: Achieving National Elective Surgery Target in Victoria](https://reader033.vdocuments.mx/reader033/viewer/2022050919/546ccdc3b4af9f842c8b5221/html5/thumbnails/71.jpg)
Thank you