Barriers to timely discharge: An outer metropolitan General Surgical unit’s experience

Dr Domenic La Paglia1, A/Prof Shiran Wijeratne2

1Western Health, Melbourne, Australia, 2Werribee Mercy, Werribee, Australia



We have conducted a comprehensive audit of 125 surgical admissions over a 3-month period in an outer metropolitan hospital. Challenges faced by our health service include lack of access to critical care beds, lack of availability of specialised services and lack of an integrated digital medical record, which are factors faced by many rural health services. These factors have been shown to cause delays to patient care and have lengthened the average hospital stay, unnecessarily consuming taxpayer funds. This has highlighted several areas where technological advances and implementations could be utilised to streamline processes and reduce delays.

What is happening in your project/ health service/or what has been your experience:

Our health service lacks a critical care facility, meaning any high acuity patients must be transferred in order to receive appropriate care. We face ongoing challenges in securing beds for transfer and there are often lengthy delays as a result. In our audit three patients were shown to have delays to transfer of greater than 24 hours, compromising patient care. Nine patients experienced significant delays while awaiting theatre availability. Multiple patients required transfer for specialised procedures such as ERCP and experienced delays in the process. Many of these delays were a result of inefficient processes which exist to locate an appropriate transfer destination. Furthermore, the lack of any digital medical record to process patient information, discharge letters and summaries and scripts compounded these issues.


The implementation of readily available technology to streamline processes and improve data records would be cost effective and would improve service delivery at public health services in regional Australia.




Dr Domenic La Paglia MBBS DipAnat MPH MSc