November / December 2023

This tool highlights key topics covered at the Perioperative (Surgical) Services Network, along with other Perioperative Services related updates.

Please share with your teams and encourage others to subscribe to

ongoing updates below. Past highlights can be found here.

In this issue:

• Surgery strategy updates
• eReferrals updates
• NSCATS
• Anesthesia technicians
• Waitlist management and scheduling
• Policy updates
• In the News
• Perioperative Nurses Week

Our teams across the province are making progress in reducing the wait list for surgery and supporting other improvements and efficiencies. Our Surgical Access and Quality Improvement Strategy focusses on increasing capacity, improving quality and efficiencies and reducing, diverting or better distributing demands across the health system. Updates on our progress and key initiatives are featured below.

Surgical volumes and OR hours up:

• Up 2046 cases this YTD compared to last, and up 324 cases compared to 19/20.
• OR hours of use up 4012 hours this YTD compared to last.
• Outpatient joint replacements up to 1018 this year vs. 857 last year and 51 in 19/20 (YTD comparisons)
• 1,854 more cataract surgeries completed at Halifax Vision Centre so far this year compared to last YTD, and 2,477 more than the same timeframe in 21/22.

Wait lists down:

• Surgery wait list down to 18,808 this November vs. 22,237 last November.
• Endoscopy (excludes CZ) wait list down almost 5000 cases this November vs. last November (12,149 vs. 17,107)

Wait times:

• Surgeries in wait target: 54%, vs. 51% last year / 60% in 19/20.
• Endoscopies in wait target: 52% vs. 42% last year / 56% in 19/20. (excludes CZ).
• Higher percentage of patients are receiving cataract surgeries and hip and knee replacements within the national benchmarks compared to 22/23.
• Some areas seeing notable gains including Northern Zone, which went from 43% of patients receiving cataract surgery in target in April of this year, to 85% during the month of November.

Source: PAR-NS Dec.18/23

Using electronic referrals (eReferrals) to improve access to care is a priority within government’s Action for Health Plan and Nova Scotia Health's Surgical Access and Quality Improvement Strategy. It has has been adopted as the provincial standard for managing and coordinating referrals for surgeries and diagnostic imaging (DI) services.

Mandatory use of eReferrals

Following a period of transition and enhancements for primary care providers and surgeons, we are now further expanding user supports and making eReferrals use mandatory for these providers, effective April 1, 2024.  View Memo and FAQs

eReferrals expanded to include MRIs and ultrasounds

eReferrals expanded to include MRIs in September and ultrasounds in December. View news release. In-person support is available to help surgeons and their teams use the tool to send and receive referrals. Request support at: www.referralsns.ca/ask.

Surgeon representation needed

Since the summer a Primary Care eReferral Advisory Group has been engaged, offering input into various aspects of the eReferrals tool and workflows, the supports available to users and more.

We also wish to identify surgeons who can inform this work. We know attending regular meetings may be challenging, so are seeking representatives who can offer input through asynchronous reviews or ad-hoc discussions with our team. Your input is needed to understand surgeons specific challenges, opportunities for improvement, resource needs and more. If you are interested or want to learning more please email: [email protected]



eReferrals supports visibility into referral status

With the traditional approach of having referrals sent directly to surgeons, there was no way to know how many were being sent or where, if they were received, lost or misdirected, or their status or outcome. We are gaining valuable information to help with planning and our central intake staff can review and follow-up on referrals that are not accepted in the tool, to help prevent delays.

• Nearly 12,000 surgical referrals have been sent in eReferrals to date, with the highest weekly volumes to date last week.
• 43% of eReferrals included an email address to allows patients to get automatic notifications on their referral. This improves patient satisfaction and can reduce calls to primary care and surgeon offices.
• More than 451 unique providers have submitted a surgical eReferral.
• More than 440 primary care providers and their administrative staff and more than 160 surgeon offices have taken advantage of direct supports.

Five Key eReferrals Steps for Surgeons' Offices

As a secure, closed-loop system, eReferrals offers many benefits that can be fully realized when it is routinely used to manage and update referrals as activity occurs. There are five key steps Surgeon Offices must take for each eReferral received. View Memo and Printable Resource.  

Enhancements and updates

Since launching eReferrals we have been listening and learning from users, translating their feedback into enhancements to the tool and processes and developing additional resources and supports. Key enhancements to date include:

• New: When anticipated wait time to appointment is added, automatic notifications are now sent to referring providers, as well as patients, if they supplied an email address.
• The referring provider populates in the provider field within both Accuro* and Med Access. *Accuro users must have an administrative Ocean user with your office reauthenticate your Ocean Cloud Connect for this to occur.
• An extension for Med Access users with Chrome or Edge browsers was launched in June to save time and steps when attaching files to referrals.

Learn about recent and previous enhancements in our latest eReferrals enhancement bulletin.

Learn more about efforts to improve access and care:

• View government's Action for Health Progress Reporting page.
• Visit the Health Transformation Hub

Our Nova Scotia Coding Access Targets for Surgery (NSCATS) identify the maximum acceptable surgical wait times for various procedures to help prioritize care and support appropriate and timely bookings.

New ENT codes are being proposed for tonsillectomy +/- adenoidectomy. Watch for further updates on this soon. Discussions are also occurring regarding the next specialties to be pursued.

Please refer to the current codes and instructions below.

Eastern, Western and Northern zones:

• General Surgery
• Urology
• Otolaryngology

Central Zone

• General Surgery

A presentation was provided at the November Perioperative Network meeting regarding anesthesia technicians and the role they serve as anesthesia extenders. A review of the role was recently completed by Interprofessional Practice and Learning. View presentation.

At the November Network meeting, team members received updates on a number of items related to wait list management and scheduling, including:

• a presentation regarding the modified Lucas Report Booking Tool. Surgeons who want access can send a request to their zone PAR-NS Access Coordinator.
• A demo on block scheduling, which is continuing to be refined. This tool will help with scheduling and will also help to track utilization - reasons for closures / reductions, which is occurring manually now.
• A new approach to determining what is an appropriate targetted waitlist -- based off NSH data and the National Health Service's method (United Kingdom).

Coming Soon!

Watch for more news in early January regarding our new Epidural Analgesia and Catheter Removal Policy (non-obstetrical).

Our Policy News & Development page provides information and updates on new and updated Perioperative Services policies, procedures and care directives. We also use this page to seek feedback on items under review and development to ensure the needs and impacts on our teams and patients are considered. 

Yarmouth Regional Hospital recognized by the American College of Surgeons

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has recognized Yarmouth Regional Hospital as one of 78 ACS NSQIP participating hospitals that have achieved meritorious outcomes for surgical patient care in 2022.  

See full story.

Learn more about NSH's participation in NSQIP

Cardiac outreach clinics increase access to care

Heart patients in the Sydney and Yarmouth areas can receive specialized care closer to home thanks to the Cardiac Outreach Clinic initiated and sponsored by Halifax-based cardiac surgeons.

See full story.

Surgery intake referral officer, Megan Adams take pride in connecting patients and providers

Nova Scotia Health and IWK Health Central Intake teams are the hub of Nova Scotia's new approach to better manage and coordinate surgical referrals, with the goal to enhance communication with patients and providers, support more timely access to care and provide better information to support planning.

See full story.

Valley Regional Hospital initiative comforts and reduces infections in patients 

Patients having surgery at Valley Regional Hospital (VRH) will get a sense of warmth and comfort through specialized warming systems being used to enhance patient safety and care. 

See full story.

Pain management pilot seeks to enhance pain support for patients after surgery

Working alongside Dr. Michael Dunbar, orthopedic surgeon and QEII Foundation Endowed Chair of Arthroplasty Outcomes and orthopedic surgeons, Dr. Glen Richardson, Dr. Jennifer Leighton and Dr. Duncan Smith, clinical pharmacist, Dr. Emily Johnston launched a pain management pilot to help patients manage their pain after their surgery.

See full story.

Nearly 500 patients benefit from Stewart E. Allen Hybrid Operating Room in its first year of operation

The QEII Health Sciences Centre recently reached the one-year anniversary of the Stewart E. Allen Hybrid Operating Room (OR) which combines advanced imaging technology within an operating room. 

See full story.

See our News Makers page for other Perioperative related stories.

(Note: some links are being updated as part of the new

Nova Scotia Health website - www.nshealth.ca)

Story idea to share?

Email: [email protected]

November 12 to 18 marked Perioperative Nurses Week which honours and recognizes the dedication and impact of perioperative nurses. The theme of this year’s week was: “Standing for Patient Safety and Excellence in Surgical Practice,” something we count on our exceptional colleagues to promote and support each day for our patients.

In all aspects of the surgical journey, from pre-operative assessment to recovery, perioperative nurses have an integral role in providing care for their patients and supporting surgical teams in and out of the operating room.

Perioperative nurses, Jacqueline Deal, Cheryl Leon-Reid and Laura Robichaud, from the QEII Health Sciences Centre - Halifax Infirmary site, and Megan Reid, from Cumberland Regional Health Care Centre, tell us about their roles HERE.

Find Patient Education Resources supported by Library Services:

1. Search by topic/category (e.g. Otorhinolaryngology) - HERE
2. Type in the last four digits of the print code in the search box HERE

Subscribe to Library Services blog for monthly updates on new / updated resources. View resources posted in November 2023

Network Contacts

Dr. Greg Hirsch, Senior Medical Director, Perioperative Services Network

Cindy Connolly, Senior Director, Perioperative Services Network

Liam Shannon, Manager, Planning and Development, Perioperative Network

Stephanie Mailman-Crouse, Quality Improvement and Safety Advisor

Sara Bates, Senior Analyst, Policy and Planning, Perioperative Services Network

Sarah Miles, Central Intake Office Manager, Perioperative Services Network

Karen Doherty, Clinical Project Consultant, Perioperative Services Network

Robin Lake, Network Leader, Perioperative Services Network

Sandra Kline, Admin. Assistant, Perioperative Services Network and NSQIP

Debbie Dolliver, Admin. Assistant, Surgical Quality & Access Improvement Strategy

Krista Wood, Senior Communications Advisor, Perioperative Services

Sabina Pollayparambil, Communications Advisor, Perioperative Services

More Information and Updates

View our Perioperative Services page on the Nova Scotia Health Physician Information and Wellness Portal 

Visit our Perioperative (Surgical) Services page within the programs and services section of the Nova Scotia Health intranet for past highlights, newsletters and more.

View our Nova Scotia eReferral Resource Hub for information and resources related to eReferrals, including tutorials, FAQs, tip sheets and more.

Questions, feedback or story idea?

Email: [email protected]