Dear Insert Referring GP

Dear [insert referring GP]

Re: [insert patient name] [Insert patient address] [Insert patient date of birth]

UR number: [insert UR number]

The above patient has been registered on the elective surgery waiting list at [insert hospital] for [insert planned procedure] as clinical urgency [insert urgency category 1, 2 or 3] with [insert attending medical officer] and is listed as [insert listing status].

The hospital seeks to provide patients with treatment within the desirable timeframe for their particular clinical urgency. The Elective Surgery Access and Waiting List Management Policy outlines that if the treating Specialist is unable or is unlikely to be able to provide treatment in the recommended timeframe, the hospital will offer the patient the following options:

 Transfer from one Specialist to another within the same hospital.  Transfer to another hospital and/or another Specialist that performs the procedure and where a shorter waiting time to admission is available.

While your patient is waiting for their procedure, we request that you continue to monitor their progress and notify the hospital if there is a change in their condition.

Should you have any queries relating to the information provided in this letter, please contact the hospital on [insert contact number] between 9.00 AM - 4.00 PM Monday to Friday.

Yours sincerely

[Insert name] [Insert current date] Appendix 10: Booked Procedure - Patient Dear [insert patient / guardian name]

Following our previous correspondence, the following arrangements have now been made for you to have your procedure at the [insert hospital name] under the care of [insert treating Specialist] on [insert planned admission date].

To confirm your procedure details, please phone [insert contact phone number] at least one week prior to your procedure date.

Pre-admission clinic Before your procedure, you are required to attend the pre-admission clinic. At the pre- admission clinic your current health will be reviewed and education regarding surgery will be provided. Your pre-admission appointment is booked on:

Day: [insert appointment day and date] Time: [insert appointment time] Location: [insert pre-admission clinic location]

Please bring this letter to your appointment, together with any relevant x-rays, scans (e.g. CT or ultrasound), blood test results, a list of any medications you are currently taking and your Medicare card.

Procedure details Your procedure details are: Doctor: [insert attending medical officer] Day: [insert appointment day and date] Time: [insert appointment time] Location: [insert hospital location] Length of stay: [insert estimated length of stay]

The cancellation of pre-admission clinic appointments and booked procedures is highly inconvenient for all involved. When patients fail to attend appointments this leads to delays for many other patients waiting as well as wasted time and resources. We would appreciate your assistance in ensuring that if you no longer require your procedure or are unable to attend your appointment that you contact the hospital on [insert contact number] or for pre-admission clinic appointments, phone 1300 855 275 Monday to Friday 8am-7pm. The demands on our public health system require that any patient who declines two offers of a clinic appointment or two offers of a planned admission date or fails confirmed bookings will be removed from the elective surgery waiting list. On your operation day, remember to bring with you: • This letter and any forms you have been asked to complete. • Medicare card, Pension or Health Care card • Current medications • Nightwear, personal toiletries, comfortable fitted shoes or slippers. Additional information about your procedure: [Insert as required] • Fasting requirement • Expected length of stay • Special instructions Do not bring valuables or large sums of money with you, as all personal items brought into the hospital are your responsibility. Please ensure that you have discussed with the pre-admission service staff before this admission any specific discharge requirements (e.g. home equipment needs, allied health follow up appointments, HACC services, transportation requirement) to facilitate your timely discharge from hospital. If you require attention for your condition while waiting for your pre-admission clinical appointments or procedure date, we would urge you to contact your GP, or in an emergency attend your nearest hospital emergency department.

Yours sincerely

[Insert name] [Insert current date] Appendix 11: Booked Procedure – GP Letter Dear [ insert GP]

We wish to advise that the following arrangements have been made for your patient to be admitted to [Insert hospital name] under [insert attending medical officer] as per the following:

Pre-admission clinic: Day: [insert appointment day and date] Time: [insert appointment time] Location: [insert pre-admission clinic location]

Procedure details: Doctor: [insert attending medical officer] Day: [insert appointment day and date] Time: [insert appointment time] Location: [insert location]

Your patient has been notified of these details and has been requested to contact the hospital if unable to attend. Regrettably, the demands on our public health system require that any patient who declines two offers of a clinic appointment or two offers of a planned admission date or fails to confirm bookings will be removed from the elective surgery waiting list. A new referral would then be required.

While your patient is waiting for their procedure, we would ask that you continue to monitor their progress and notify the hospital if there is a change in their condition.

Yours sincerely [Insert name] [Insert current date] Appendix 12: Missed Booking (not re-booked) – Patient Letter

Dear [insert patient name]

Our records indicate that you did not attend [insert pre-admission clinic appointment or hospital] for your procedure on [insert date]. If you still wish to have your procedure, you are required to phone [insert name of designated officer] on [insert contact number].

Cancellation of pre-admission clinic appointment and booked procedures means that resources which might have been used to treat other patients are wasted.

The demands on our health system require that any patient who declines two offers of clinic appointments or two offers of an admission date or fails to respond will be removed from the elective surgery waiting list. A new referral would then be required.

If you still require your operation please call the hospital on the numbers listed above within 14 days. If you do not contact us, your name will be removed from the elective surgery waiting list and you will require a new referral from your GP in order to be considered for a procedure.

Should you have any queries relating to the information provided in this letter, please contact the hospital on [insert contact number] between 9.00 AM - 4.00 PM Monday to Friday; alternatively you can speak with the hospital patient liaison officer.

Yours sincerely

[Insert name] [Insert current date] Appendix 13: Missed Booking (not re-booked) – GP/Specialist

Dear [insert treating Specialist or GP]

Recently the above patient was booked for [insert pre-admission clinic appointment or p r o c e d u r e . Unfortunately, due to circumstances not known by the hospital, the patient failed to attend the hospital on the scheduled day.

The hospital has been unsuccessful in contacting the patient to arrange a new appointment or procedure date. If all attempts at contacting the patient are unsuccessful, the patient may be removed from the elective surgery waiting list in line with the WA Health Elective Surgery Access and Waiting List Management Policy.

The demands on our health system require that any patient who declines two offers of an a p p o i n t m e n t o r admission date or fails to respond will be removed from the elective surgery waiting list. A new referral would then be required.

Any assistance you could provide in contacting the patient would be appreciated.

Yours sincerely

[Insert name] [Insert current date] Appendix 14: Removal from the ESWL – Patient

Dear [insert patient name]

Our records indicate that you did not attend [insert pre-admission clinic appointment or hospital] for your procedure on [insert date] and have not contacted the hospital to within the required 14 days.

The demands on our health system require that any patient who declines two offers of clinic appointments or two offers of an admission date or fails to respond will be removed from the elective surgery waiting list. A new referral would then be required.

Your name will now be removed from the elective surgery waiting list.

Yours sincerely

[Insert name] [Insert current date] Appendix 15: Removal from the ESWL – GP/Specialist

Dear [insert treating Specialist or GP]

Recently the above patient was booked for [insert pre-admission clinic appointment or hospital] for their [insert procedure]. Unfortunately, due to circumstances not known by the hospital, the patient failed to [attend the hospital on the scheduled day or respond to [Missed Pre-admission or Procedure letters].

The hospital has been unsuccessful in contacting the patient to arrange a new appointment or procedure date. As several attempts at contacting the patient have been unsuccessful, the patient has been removed from the elective surgery waiting list in line with the WA Health Elective Surgery Access and Waiting List Management Policy. Or The above patient was waitlisted at [hospital] for a [procedure]. Recently the patient [declined two offers of a clinic appointment or two offers of admission dates; or failed to respond to contact attempts by the hospital; or has requested to be removed from the waiting list]. The patient has now been removed from the waiting list and no further arrangements for care have been scheduled.

The demands on our public health system require that any patient who declines two offers of clinic appointments, two offers of an admission date, fails to respond or requests to be removed from the waiting list will be removed. If the patient still requires their procedure, a new referral is now required.

Yours sincerely [Insert name] [Insert current date] Appendix 16: Audit Letter - Patient

Dear [insert patient’s name]

We are continually monitoring and updating our elective surgery waitlist so it remains accurate, complete and ensures timely access to our services. To assist us in keeping our waiting list accurate we request that you complete the section over the page and return it in the envelope provided within 10 days.

We acknowledge that you may have previously received and replied to this request, and apologise for any inconvenience caused, however it is important that this information is obtained regularly and our records updated.

If you require attention for your condition while waiting for your pre-admission clinical appointment or procedure date we urge you to contact your GP, or in an emergency attend your nearest hospital emergency department. Changes in your condition or general health may have implications for the timing of your procedure or lead to your clinical priority category being re-assessed.

If you do not confirm that you wish to remain on the list within 10 working days of receiving this letter, one other attempt will be made to contact you. If there is still no response you may be removed from the hospital’s waiting list, in consultation with your doctor.

Yours sincerely

[Insert name] [Insert current date] Please complete the following section:

Do you still require your procedure? YES NO

If you ticked NO, please indicate the reason: I have already had the procedure I no longer require the procedure I no longer wish to have the procedure Other (please specify): ______

Current contact details Address: ______

Phone number: Home:______Mobile:______Work: ______

Current GP details Name: ______Address: ______Phone no.: ______

Thank you for taking the time to complete this form. Please sign below and return it in the envelope provided within 10 working days.

Patient/Carer Name: Patient/Carer Signature: ___

Date:____/__ _ /