Output 1.1 - Acute Services

The Canberra Hospital provides a comprehensive range of acute care, including inpatient, outpatient, and Emergency Department services. The key strategic priority for acute services is to deliver timely access to effective and safe hospital care services.

This means focusing on:

  • strategies to meet performance targets for the Emergency Department, elective and emergency surgery

  • continuing to increase the capacity of acute care services.


Acute services are provided by:

  • the Division of Critical Care

  • the Division of Medicine

  • the Division of Pathology

  • the Division of Surgery, Oral Health and Medical Imaging

  • the Division of Women, Youth and Children.

Division of Critical Care

The Division of Critical Care is responsible for delivering acute and critical care and providing retrieval services. These are provided as inpatient and outpatient services at Canberra Hospital, with a strong emphasis on accessible and timely care, delivered to a high standard of safety and quality. This is underpinned by the division’s commitment to research and training. The division includes the:

  • Retrieval Service (both road and air)

  • Emergency Department

  • Intensive Care Unit (ICU)

  • Access Unit

  • Surgical Short Stay Unit

  • Acute Surgical Unit (ASU)

  • Discharge Lounge and Medi-Hotel

  • Medical Assessment and Planning Unit (MAPU).

Division of Medicine

The Division of Medicine provides adult medicine services to the Canberra community in inpatient, outpatient and outreach settings. An emphasis is placed on accessible, timely and integrated care, which is delivered to a high standard of safety and quality.

The Division of Medicine comprises:

  • Renal Services

  • Cardiology

  • Academic Unit of Internal Medicine

  • Sexual Health Centre

  • Neurology

  • Gastroenterology and Hepatology

  • Dermatology

  • Diabetes Service

  • Endocrinology

  • Forensic and Medical Sexual Assault Services

  • Infectious Diseases

  • Inpatient Ward Services, Ambulatory Clinics and Clinical Measurement Services across many specialties

  • Pharmacy Services

  • Respiratory and Sleep Services

  • Rheumatology.

The division has a strong commitment to teaching and research. Health students from several universities undertake practical placements within the division. Most of the division’s senior medical staff holds academic appointments at the ANU Medical School, and many research programs are in operation. Many members of the division’s staff participate in developing national professional guidelines and quality initiatives.

Division of Pathology

Pathology is a medical specialty that examines disease processes and their cause. Services are provided in the acute setting at Canberra Hospital, Calvary Hospital, the National Capital Private Hospital and in the community through collection centres across the ACT. A home collection service for patients who are frail or unwell and who cannot attend these collection centres is also provided.

Pathology is a demand-driven service that plays a critical role in more than 70 per cent of clinical diagnoses and many of the decisions around optimal treatment for patients. Due to the critical role of pathology testing in diagnosis and treatment, the objective and direction for pathology are intimately tied to the objectives and priorities of ACT Health’s Corporate Plan.

Pathology works in close collaboration with many areas of the Health Directorate to provide access to accurate, timely results to assist in diagnosing, managing and monitoring patients.

In line with Health Directorate objectives, Pathology supports Canberra Hospital, Calvary Hospital and the community in numerous ways, including:

  • infection control

  • public health outbreaks (Norovirus, Measles, Flu, Tuberculosis, Meningococcal, etc.)

  • Emergency Department.

Pathology also performs testing for the ACT Breast Screening and Cervical Screening programs.

Division of Surgery, Oral Health and Medical Imaging

The Division of Surgery, Oral Health and Medical Imaging is responsible for delivering:

  • inpatient and outpatient surgical and medical imaging services

  • prevention and treatment dental health programs for children, targeted youth and adults of the ACT and surrounding region.

The division includes:

  • Surgical Bookings and Pre-Admission Clinic

  • Anaesthesia

  • Pain Management Unit

  • Operating Theatres

  • Post-Anaesthetic Care Unit

  • Day Surgery Unit and Admissions / Extended Day Surgery Unit

  • Medical Imaging

  • specialist surgical ward areas

  • medical and nursing outpatient services

  • Shock Trauma Service

  • Trauma and Orthopaedic Research Unit

  • the ACT Dental Health Program.

Division of Women, Youth and Children

The Division of Women, Youth and Children provides a broad range of primary, secondary and tertiary healthcare services. The provision of services is based on a family-centred, multidisciplinary approach to care in partnership with the consumer and other service providers. Services are provided:

  • at Canberra Hospital

  • in community health centres and

  • in community-based settings, including clients’ homes, schools, and child and family centres.

Some services are provided within other agency facilities.

The Division of Women, Youth and Children comprises:

  • maternity services, including the:

    • Continuity at the Canberra Hospital (CatCH) Program

    • Canberra Midwifery Program (CMP)

    • Maternity Assessment Unit (MAU)

    • Early Pregnancy Assessment Unit (EPAU)

    • Fetal Medicine Unit (FMU)

  • women’s health, including:

    • health screening

    • gynaecology

    • programs targeting violence against women

    • the Women’s Health Service, which prioritises women who experience barriers to accessing mainstream services

  • neonatology, including:

    • the Neonatal Intensive Care Unit (NICU)

    • the Special Care Nursery (SCN)

    • specialist clinics

    • newborn hearing screening

    • the ACT Newborn Retrieval Service

  • paediatrics, including:

    • inpatient care

    • specialist clinics

    • community paediatricians

  • a genetics service

  • the Maternal and Child Health (MACH) nursing service, including:

    • a universal home visit following birth

    • breastfeeding and parenting support

  • immunisation and referral services that support children and their families with complex care needs, including:

    • the MACH Parenting Enhancement Program

    • the Asthma Nurse Educator Service

    • the Caring for Kids Program, which supports care in the home for children with complex needs

    • the Child at Risk Health Unit, which supports care for children affected by violence and abuse

    • Integrated Multi-agencies for Parents and Children Together Program, which coordinates care for woman with complex care needs who are pregnant and/or have young children

    • child protection training for clinicians

    • the Healthcare Access At Schools (HAAS) Program

    • school-based nursing services, including immunisation, kindergarten health checks, school youth health checks and the HAAS Program

    • nurse audiometry, which provides hearing assessments to children and adults.

Performance against accountability indicators

The Dental Health Program has continued to achieve the mean waiting time target for clients on the dental services waiting list. This is now set at six months, which is a reduction of six months when compared to previous years. The Dental Health Program has improved on the target with clients on the waiting list having a year-to-date (YTD) mean waiting time of 4.15 months at the end of June 2015. In June 2014, the YTD mean waiting time was reported at 5.01 months and in June 2013 YTD, it was 11 months.

The National Partnership Agreement for dental Adult Waiting List Times has been extended by the Commonwealth until 30 June 2016. This initiative has enabled the ACT Restorative Waiting list to be reduced and achieve a lower than six month mean waiting time. The KPI to meet is set at six months. At the end of this initiative the ACT waiting time will need to be reviewed.

More information: For additional information, see C.6 Statement of performance, Output 1.1: Acute Services.

Emergency Department

The Emergency Department continues to face challenges associated with an increase in patients presenting for treatment in comparison to the 2013–14 financial year. Similarly, the ICU faces challenges with an increase in:

  • patients requiring admission

  • the acuity of patients requiring admission.

The increasing number of presentations to the Emergency Department will continue to impact on the demand in the Emergency Department. However, there is a whole-of-hospital focus on initiatives to enhance access to care at Canberra Hospital.

Emergency surgery

Canberra Hospital is the major tertiary and trauma referral centre for the ACT and surrounding NSW. This means that it needs to be equipped and able to manage high volumes of trauma and emergency cases that cannot be provided by other facilities.

The increasing demand for elective and emergency surgical procedures has continued into the 2014–15 period. ACT Health continues to change where and how surgery is delivered in the ACT, to ensure that patients are receiving their surgery in the right facility at the right time.

Elective surgery

From 2009–10 to 2013–14, ACT public hospitals made significant improvements in how quickly patients access their elective surgery and within the clinically recommended timeframes. These improvements have continued into 2014–15.

On 20 October 2014, the AIHW released their latest report on elective surgery waiting times performance over 2013–14. While the ACT’s result of 48 days for 2013–14 is still above the national average of 36 days, in 2009–10, the ACT reported a median wait time to surgery of 73 days, which is not the highest national median wait time.

The Surgical Services Re-alignment Program is being led by the Performance Information Branch to provide short-, medium- and long-term planning for surgery across the territory and surrounding region. The main principle underpinning the re-alignment is to provide a regional approach to surgical services that achieve better patient outcomes and best utilise all available public hospital resources.

Acute Care services

The Acute Surgical Unit (ASU) commenced in April 2015 and is staffed and run by consultants at Canberra Hospital. The ASU admits patients who have been assessed as likely to require a surgical procedure and aims to maximise access to emergency theatre time for general surgery patients. The ASU has access to a dedicated theatre list from Monday to Friday.

Following on from the ICU extension, which was completed in October 2013, an additional two ICU beds opened in 2014–15. This has provided efficiencies in bed management because it allows patients to be isolated or positioned further away from other patients, as required.

The Capital Region Retrieval Service was successful in securing funding to purchase a road vehicle to improve patient care and road retrieval response times. The Capital Region Retrieval Service continues to see an increase in annual total activity (Missions and Consults) from 702 in 2013–14 to 786 in 2014–15.

The ACT Government funded Canberra’s first Mobile Dental Clinic, which was launched in January 2015. The purpose-built truck is improving access to dental health services for Canberrans residing in aged care facilities. In the first six months it visited seven facilities, providing a range of preventative, restorative and denture services.

A dedicated nursing Trauma Case Management Service commenced within the Shock Trauma Service. Funding for the appointment of a Nurse Practitioner in the Shock Trauma Service has been confirmed. The goals of trauma case management (TCM) are to:

  • provide well-coordinated care for patients and families

  • ensure that satisfactory clinical outcomes are met.

In addition, the service aims to effectively manage patient length of stay and hospital resources by improving the integration and coordination of the activities of multiple sub specialties.

A new Cardiac Catheter Diagnostic Suite (CCDS) was installed in the Cardiology Department at Canberra Hospital in 2014. This has provided enhanced clinical services for our patients. The CCDS brings a new imaging performance, enabling the clinician to ultimately treat the patient faster, with more precision and with added confidence for enhanced patient outcomes. The CCDS is the first of its kind in the ACT. The high powered X-ray tube reduces the radiation dose to the patient (and operator) by up to 60 per cent when compared to conventional imaging equipment.

During 2014–15, Cardiology implemented an integrated database that provides clinicians with a seamless flow of information and data across both clinical and diagnostic services. This has improved communication between Canberra Hospital and Health Services (CHHS) specialists and GPs and improved patient care.

An additional two non-invasive cardiologists were appointed to support and improve echocardiography at Canberra Hospital. The appointments have significantly improved access and, as a result, there is no longer a wait time associated with the echocardiography service for inpatients.

The Canberra Hospital’s Coronary Care Unit (CCU) opened at Woden Valley Hospital on 16 June 1975, under the direction of Dr David Coles and RN Judy Foskett. The CCU now has:

  • nine cardiologists

  • 35 CCU nursing staff

  • 24-hour medical cover.

During 2014–15, it celebrated its 40th anniversary. The CCU has established and maintained a high-quality service for Canberra and the surrounding region.

Following the completion of renovations to the Gastroenterology and Hepatology Unit (GEHU) in 2014 and the allocation of an additional $300,000 in enhancement funding in 2014–15, overall patient flow and capacity has increased. This has allowed an additional 300 procedures to be completed, which assisted in reducing the waiting list and improved timely access to this service in the territory.

A dedicated 20-bed Gastroenterology and Hepatology Medical Inpatient Unit opened and accepted its first patients on 18 November 2014.

Hospital in the Home (HITH) has increased its capacity to deliver the service by increasing the number of Registrars who visit and treat patients within their own home. In addition, through the Capital Upgrades Program (CUP), enhancement funding is being used to expand the HITH service, which will increase the physical treatment space at Canberra Hospital. This upgrade will:

  • allow patients to receive treatment from clinicians in a safe clinical space in a timely manner

  • support the ongoing HITH service and improve overall patient satisfaction.

This work is due to be completed in September 2015.

In 2014–15 and into the beginning of 2015–16, the Northside Dialysis Unit will relocate from Calvary Hospital to the Belconnen Community Health Centre (BCHC), where an expanded service will be offered. The move offers a number of advantages to clients accessing the service, including:

  • easy access to co-located allied health services, including dieticians and podiatry

  • longer opening hours, with plans to offer nocturnal dialysis.

This will make BCHC the first public nocturnal dialysis provider in Australia. In addition, dialysis services are also now offered in the refurbished Tuggeranong Community Health Centre, which commenced treating patients on 25 May 2015 and offers 12 dialysis stations.

The Division of Medicine’s inpatient sleep laboratory provides opportunities to interpret complex sleep studies. Four additional clinical staff have recently been recruited. This has resulted in an increased ability to meet the demand for this service, improving access for patients and referring clinicians.

Canberra Hospital, as the only Level Three Tertiary hospital for the ACT and surrounding regions, accepts patients who cannot be accepted by non-tertiary facilities due to the patient’s clinical indications. The dual demands of occupancy and acuity are impacting on Canberra Hospital’s ability to provide tertiary-level care to women and their babies.

In response to the escalating demands for maternity services at the Centenary Hospital for Women and Children (CHWC), the Canberra Hospital has been working closely with Calvary Public Hospital and Queanbeyan Hospital to determine ways of better managing maternity services across the ACT and the surrounding region.

Early intervention and prevention

The Shock Trauma Service received a grant from the NRMA ACT Road Safety Trust to pilot the Prevent Alcohol and Risk-Related Trauma in Youth Program (PARTY Program), in response to an increasing trend in alcohol-associated harm and hospitalisation in the ACT. The program, targeted at high school students, involves the students:

  • hearing talks from ambulance workers and trauma surgeons

  • participating in tours of the hospital

  • interacting with rehabilitation equipment

  • meeting young trauma survivors.

The HAAS Program provides nurse-led care to students with additional healthcare needs while they attend ACT Government schools. The model includes a HAAS Registered Nurse (RN) who works with the family and others involved to develop a care plan for the student. The RN then trains the school Learning Support Assistant (LSA) in the specific healthcare tasks required to support that particular student. These are often the same tasks that are undertaken by family members or carers when the child is not at school.

Due to some concerns from the community, ACT Health in collaboration with the Education and Training Directorate (ETD), has reviewed the needs of children in specialist schools and has undertaken a consultation process regarding HAAS and the role of nurses in specialist schools. The consultation process involved Health, ETD, teachers, unions and parents. This work will be completed by August 2015.


Demand for pathology requests increased in 2014–15. Table 19 shows the number of pathology requests received, the total number of tests performed and the percentage increase.

Table 19: Pathology requests




% increase

Total requests




Total tests





Australian Council on Healthcare Standards (ACHS) Clinical Indicators demonstrate timeliness of reporting of results for selected Canberra Hospital Emergency Department tests. As shown in Table 20:

  • the potassium result is regularly above target

  • the haemoglobin result regularly meets target

  • the coagulation result is below target, which reflects a definition issue that does not take into account the centrifugation time required in sample preparation.

Table 20: ACHS Clinical Indicators



ACHS target

Potassium (% results in <60 minutes)



Haemoglobin (% results in <40 minutes)



Coagulation testing (% results in <40 minutes)




ACT Pathology holds Royal College of Pathologists of Australasia (RCPA) accreditation for medical postgraduate pathology training in all of the major pathology specialisations. We work in collaboration with the University of Canberra, ANU and CIT to continue to develop and support the various scientific and technical courses required to support medical laboratory science.

ACT Pathology staff undertake continuing education by attending external conferences of national associations and industry workshops.

Pathology Division is a scientific discipline with research as a cornerstone. We participate in many research projects and many of our pathologists and scientists are actively involved in their own research or work collaboratively with others.

Members of the division (scientific and medical) continue to publish actively in peer-reviewed journals and participate in professional meetings and workshops both in Australia and overseas.

Telemedicine services

The Telemedicine network is now established across Southern NSW and the ACT and incorporates:

  • 12 hospitals in Southern NSW

  • the two ACT public hospitals

  • the SouthCare rescue helicopter base at Hume.

Health Pathways

The Division of Medicine clinical units have been a major player in the rollout of Health Pathways. This was developed in collaboration with the ACT Medicare Local to articulate and publish pathways of care across the continuum, in collaboration with Canberra and regional GPs.

Health Pathways has been developed to increase the quality of referrals to specialist services and improve the wait time for patients accessing specialist care. The system provides evidence-based guidelines to manage patients within primary care and triggers for specialist referral, which are promulgated by the tertiary specialist service.

Health Pathways went live on 13 April 2015 and was launch by the Minister for Health, Simon Corbell Member of the Legislative Assembly (MLA), on 25 May 2015. There are currently 70 live pathways, including pathways for:

  • Diabetes

  • Sexual Assault

  • Early Breast Cancer Follow-up

  • Blood borne virus exposure

  • Deep vein thrombosis

  • Cardiology

  • Chronic Obstructive Pulmonary Disease.

Many more pathways are currently under development, including those for mental health services and liver conditions.

Awards and presentations

The Family-Integrated Care Program Team from NICU/SCN won the Public Team Excellence Award for their consistent commitment to parental involvement in care. The project team is examining whether the Family-Integrated Care model improves the health and wellbeing of prematurely born babies.

More information: For detailed information, see Future directions, Models of care in this section.

Future directions

Emergency Department

The HPI Branch commenced a $23 million project to deliver an expansion of the Emergency Department at Canberra Hospital, which includes delivering an integrated paediatric streaming function. The project incorporated a $5 million commitment from the Commonwealth.

The expansion and refurbishment will improve the Emergency Department’s layout, creating efficiencies that are expected to reduce waiting times. The works will include more comfortable sub waiting areas for patients waiting for treatment and a dedicated waiting and triage area for paediatric patients.

Acute Care services

The Medical Imaging Department will transition to the Division of Critical Care in 2015–16, to allow closer alignment between the department and other key stakeholders.

During 2014–15, the Capital Region Retrieval Service faced challenges in recruiting staff to its 24-hour roster. As such, in 2015–16, it will focus on identifying innovative ways to recruit further staff.

Increased admission numbers and activity levels on the paediatric ward over the winter period have created a need to develop a Paediatrics Winter Strategy. Data for this period is being collated within the division, and staffing models are being assessed for the best level of staffing to cope with the predicted increased demand.

As part of the strategy, further work is also being undertaken to formalise the management of staffing allocation and patient flow across the four inpatient wards during the high activity period. The capacity to have an overflow area (Paediatric Surgical Area) for increased admission numbers during winter is one of the components in addressing staff allocation and improved patient flow for the Emergency Department.

Currently, CHHS does not have clinics specifically for pulmonary hypertension or dyspnoea and has identified this as an area of need. Work has recently started in collaboration with Cardiology, Rheumatology and Respiratory and Sleep sub specialties to develop these services. Further research is being undertaken with regard to best practice and next steps.

The Division of Medicine has faced challenges over 2014–15 in meeting demand across all sub specialties. However, plans are in place to address this and improve access to medical services for all our patients across the territory.

Over the next year, an emphasis will be placed on the care of acute medical admissions to CHHS. This will include admission models of prevention, streamlining the flow of patients to inpatient services and streamlining discharging patients to appropriate services in the community. The Internal Medicine Unit Directors meeting will facilitate collaboration across all physician-based specialties, regardless of divisional structure.

The Division of Medicine will:

  • refine the Acute General Medicine model, incorporating the Medical Assessment and Planning Unit (MAPU)

  • continue to implement the recommendations of the CHHS Administrative Services Review, including developing a model for administrative support to the Division, with specific regard to ambulatory services

  • progress more team-based models appropriate to care across the division

  • facilitate more community-based services in the new community health centres in Gastroenterology, Liver and Renal Services

  • participate in the CHHS-wide Optimising the Patient Experience project, which will see the Division of Medicine improve access to home oxygen for clinicians and their patients discharged home from an inpatient ward.

Work is currently being undertaken in collaboration with all physician-based units at Canberra Hospital and acute allied health services to establish a physician-led Medical Admissions Unit. This unit will coordinate care and admission for referred patients from the Emergency Department to the most appropriate clinical team. This will create a more streamlined process from presentation to admission, and improve the clinical care provided to our patients, including reducing the length of stay.

The Division of Medicine has identified areas of improvement in the care of patients with Acute Coronary Syndrome (ACS) across the territory, and the transfer of these patients between Calvary Hospital and Canberra Hospital. The Division of Medicine is working with Calvary Public Hospital to ensure that improvements are aligned with the:

  • Australian Commission on Safety and Quality in Health Care national standards

  • clinical benchmarks

  • indicators for these patients.

In conjunction with the work being undertaken to improve care for patients with ACS, Cardiology is working to establish a specific Coronary Angiography Computed Tomography (CT) Service. This service will build on existing cardiology services, such as the Chest Pain Evaluation Unit, and will serve to identify underlying cardiac conditions.

Early intervention and prevention

As a result of the positive feedback of the PARTY Program, the Shock Trauma Service will seek an alternative source of funding for the program to allow it to continue and expand in 2015–16.


Pathology is working collaboratively with Health IT to introduce an electronic ward ordering system that will improve completion of mandatory information required for pathology testing and legibility. This will improve the accuracy of request information and provide decision-making support information to the requesting doctor. A pilot is expected to be available early in 2016.

Pathology works closely with clinicians at Canberra Hospital to ensure accurate patient identification in specimen collection for pathology testing. To support this, the electronic ward ordering system will include a positive patient identification (PPID) component, which will reduce misidentification and mislabelling of specimens.

The major challenge for the Division of Pathology is facing increasing demand by clinicians and patients for more rapid, specific and high-tech testing for patient management, particularly in the molecular fields of cancer gene analysis and bacterial sequencing while maintaining a skilled workforce operating 24 hours a day.

The future will see a significant increase in technology usage, including both automation and new technologies. This will require a workforce that is well informed and able to adapt to changes in laboratory practice.

Telemedicine services

The Telemedicine service will expand into managing moderately ill patients, with possible integration into the Canberra Hospital access unit and Emergency Department Admitting Officer roles.

Models of care

Enhancements to the Model of Care for both the Discharge Lounge and Medi-Hotel are planned. The aim is to improve access to the services and improve patient flow for patients being discharged from the hospital.

ACT Health has completed the framework to introduce a model of patient care that will allow privately practising eligible midwives to admit their private patients to the CHWC for birthing services. This Model of Care will be operationalised by the Division of Women, Youth and Children.

In some models of care in NICUs, parents spend significant time at the hospital with their babies and are encouraged to take on many aspects of their baby’s care, once their baby is stable. This model is called ‘Family-Integrated Care’. The Family-Integrated Care model has been successfully introduced to a small group of patients at Mount Sinai Hospital in Toronto, Canada, and is now extended to more families in NICUs across Australia and New Zealand.

To understand whether this Model of Care is better for parents and their babies, the NICU and SCN at Canberra Hospital are participating in an international, randomised trial. This study examines whether the Family-Integrated Care model improves the health and wellbeing of prematurely born babies. Parents and babies will be involved in this project from the time of enrolment until the babies are discharged from the hospital. Parents will be given access to small, group learning sessions and some additional support, to make it easier for them to be present in the NICU for the required length of time.

The nurse-to-patient ratio will not change. It is estimated that this study will commence at the end of July 2014 and will be completed in August 2015.

Health Pathways

The Division of Medicine identified that patient care and patient experience could be enhanced by developing a Back Pain Pathway. Back pain is a relatively common problem in the Australian community with implications for:

  • work productivity

  • mental health

  • interpersonal relationships

  • the overall health budget.

Early initial intervention using a multidisciplinary approach is effective in reducing long-term disability. The project aims to streamline the flow of patients through the Emergency Department who present with back pain, and then ensure that the patients receive the best possible care through an efficient use of CHHS resources. A working group has been established to lead this work, which will examine the inpatient and outpatient experience across all CHHS divisions and review resources within the community.

The Division of Medicine will also enhance patient care by developing an Acute Stroke Pathway. It is developing, in collaboration with the ACT Ambulance Service and Calvary Public Hospital, an evidence-based, widely-endorsed pathway for caring for acute stroke patients across the territory. The pathway will aim to result in:

  • improved timeliness to first intervention

  • decreased mortality

  • lower rates of disability

  • increased adherence to evidence-based guidelines for the management of acute stroke.

While caring for patients with ST segment elevation myocardial infarction (STEMI) and Non-STEMI (NSTEMI) patients, CHHS has identified a need to improve the transfer of care pathways. CHHS is working with Southern NSW Local Health District (SNSWLHD) to improve the transfer of STEMI patients to Canberra Hospital for care. CHHS and SNSWLHD are currently working to improve communication lines between Southern NSW hospitals and Canberra Hospital and the management of patient care.

A Service Innovation and Redesign Framework (SIRF) project is being undertaken to manage the demand and flow of patients within GEHU who require outpatient clinic visits and procedures. This project aims to improve flow, to create efficiencies and to improve utilisation of available resources.

As part of the redesign work, the Service Lead will review endoscopy pathways with a view to streamlining, including reviewing the provision of additional anaesthetics assisted lists for high risk patients. The project is due to be completed at the end of the second quarter in 2015–16.