Ophthalmic education, Orthoptics Australia

The challenges of managing surgical waitlists

The conversation about surgical waitlists post-COVID is a critical one, writes Shandell Wishart, an orthoptist who has taken on a new career challenge managing surgical lists for South Australian doctors.

Shandell Wishart.

I have been an orthoptist for 15 years. I have managed a clinical team across three different sites in South Australia and run private and public orthoptic clinics in the neuro-ophthalmology department at the Royal Adelaide Hospital.

After 14 years working as a clinically-focused orthoptist, in March 2022, I took on the added challenge of developing and managing a surgical team. This represented a move away from my clinical role at Eyemedics, to manage eye health in a different way.

Surgical waiting lists are always inevitable. Ideally no patient is on a wait list for longer than 365 days. But keeping waitlists under 12 months post COVID and in regional and remote Australia brings additional challenges.

Working with 12 doctors’ operating lists at 11 different locations with a small team of three staff, including myself, we have risen to the challenge of managing 45 surgical waitlists a month across public and private health services.

Orthoptists are well practised in delivering a multidisciplinary approach. I liaise with a broad range of health professionals including optometrists, ophthalmologists, ophthalmic assistants and nurses every day to deliver excellence in eye healthcare. 

My ability to apply this multidisciplinary approach to an operating list has meant I can effectively engage stakeholders across multiple hospitals and focus on the common goal of ensuring our patients are operated on in a timely manner.

Across Australia elective surgeries were suspended through the COVID period.  Even the relatively short suspension in South Australia has had a massive flow-on effect and adding to patient backlog.

Hospitals are short staffed (like many sectors post COVID) and surgery lists are routinely shorter than pre COVID. COVID restrictions also lead to higher numbers of staff taking sick leave and patients having to reschedule surgeries.

Each aspect has further compounded the issue of surgery waitlists. We have seen an increase in Category 1 and 2 cataract patients requiring surgery within three to six months, only pushing the Category 3 patients further down the list. It feels like a case of one step forward and three steps back.

We manage public waiting lists across country South Australia in Wallaroo, Port Lincoln, Clare and Victor Harbor. Managing waitlists in regional and remote areas of Australia has additional challenges of access to services, long travel distances for staff and patients, impacts of weather, and health infrastructure. These challenges add more complexity to an already intricate task.

Increasingly patients are choosing to self-fund their surgery to avoid lengthy public hospital waitlists. This is a substantial financial cost at a time of increased cost of living pressures, adding additional financial strain on patients. 

Employing a multidisciplinary approach is to bring together healthcare professionals from different fields in order to determine optimum treatment for patients.

Initial conversations to get the list moving is an important starting point. I’ve slowly been meeting and discussing the requirements with necessary management and key stakeholders.

My role as an orthoptist and having a clinical background has been extremely beneficial in having those conversations with executive directors of medical services, nurse unit managers and elective surgery strategy coordinators to get our ideas heard and potentially put into action.

I am thankful for the relationships I have started to develop at all locations, where we need to not only work together but also understand the limitations we all face in our corresponding workplaces. This complex role is only possible with the commitment of many managers, doctors, orthoptists and surgical teams.

The conversation about surgical waitlists, post COVID, is a critical one. The healthcare system must acknowledge that we are facing problematic public wait times for surgery and work together to make it better. 

About the author

Shandell Wishart is a senior orthoptist at Eyemedics in South Australia, and has been working for the company since graduating with honours in 2007 from LaTrobe University in Melbourne.

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