General Surgery  |  Elective Services




General Surgery

Elective Services

General Surgery referrals are prioritised by Senior Medical Officers based on the information contained within. Additional information should be attached where available. The priorisation tool used to grade referrals can be found below under Access Criteria.

  • Skin lesion referrals are to be referred via the PHO skin lesion service in the first instance where they will be prioritised.

  • Only hospital grade skin lesions referred from the PHO will be accepted at Tauranga and Whakatane Hospitals.

  • All hospital grade skin lesion referrals from the PHO will be accepted with a wait time of up to 4 months. 

All accepted referrals will be seen within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

For plastics and vascular surgery information please see their own departmental pages.


Referral acceptance is a follows:

First Specialist Assessments:

 

Waiting priority 1

Accepted

Waiting priority 2A

Accepted

Waiting priority 2B

Accepted

 Waiting priority 3

Declined

Waiting priority 3S

Declined

Waiting priority 4

Declined

Breast

Waiting priority 2A

Accepted

Waiting priority 2B

Accepted

Waiting priority 3

Declined

Waiting priority 4

Declined


At First Specialist Assessment (FSA), patients are assessed by a specialist and if surgery is required, patients are then prioritised using the National General Surgery CPAC tool.  A 0-100 score is allocated to each patient.

Prior to acceptance for surgery, patients are assessed in Anaesthetic preassessment clinic to ensure they are fit for surgery.

All patients accepted for surgery will be treated within a maximum waiting time of 4 months, unless there is a clinical reason for delay.


Surgery acceptance is as follows:

CPAC 65+

Accepted

CPAC 64 and below

Declined

 

National Access Criteria for First Assessment (ACA)
Bay of Plenty Version (June 2014)

  • Prioritisation tool for other general surgical and vascular referrals :

 

Category

Criteria

Examples (not an exhaustive list)

1 -
Immediate
  • High risk life/limb
  • Major deterioration/exacerbation with delay
  • Otherwise requiring acute admission
  • Pressing other or "psychosocial" factors
  • Symptomatic/obstructing colon cancer
  • Vomiting and gastric outlet obstruction
  • Breast cancer/young distraught patient
  • Diabetic foot sepsis/gangrene
  • Obstructive jaundice
  • Crescendo TIA/carotid stenosis
2A -
Urgent
  • Proven/likely malignancy (not BCC)
  • Alarm symptoms/signs malignancy
  • Frequent severe painful/disabling conditions
  • Significant short/medium term risks
  • Hx severe complicated cholelithiasis e.g. biliary pancreatitis
  • Hx obstructed inguinal hernia
  • Palpable rectal mass
  • Suspicious breast lump
  • FNA +ve ear and neck lump
  • Elderly iron deficiency anaemia
  • Ischemic rest pain/nocturnal leg hanging
  • Large AAA
2B - Semi-Urgent
  • Occasional/moderate pain only
  • Persisting minor disability/loss of function
  • Non-specific symptoms/signs +/- low risk demographic requiring investigation
  • Low grade sepsis
  • Mild symptoms cholelithiasis
  • Fistula-in-ano
  • IBS symptoms/young adult
  • GORD/dyspepsia/young adult
  • Anal outlet bleeding/young adult
  • Venous ulcer disease
  • Chronic pilonidal disease
  • Intermittent claudication
  • Non-specific breast symptoms/mastalgia
  • Re-excision melanoma surgery
3 -
Routine
  • Minimal functional impairment
  • Likely benign
  • Chronic/stable
  • Little short/medium term risk
  • Significant family history
  • Asymptomatic carotid disease
  • Non-specific vascular symptoms
  • FAP screening
  • Asymptomatic hyperPTHism
  • Haemorrhoids
  • Gynaecomastia
  • Small AAA
  • Epitheliomata
  • Chronic goitre
  • BCC/SCC if surgery likely to be more than "minor"
3 S -
Routine
  • Same as Grade 3 but likely to require  surgery
-
4 -
Routine
  • Minor/nil loss of function
  • Minor/nil discomfort
  • Benign or low grade malignant
  • Self limiting
  • Low risk
  • Uncomplicated hernia
  • Lipoma
  • Seb cyst
  • Cosmetic (scars/tattoos)
  • Ganglion
  • Low risk "screening"
  • Skin tags
  • Minor BCC/SCC surgery


Notes:

  • "Clinical Priority" criteria are a guide rather than exhaustive, complete or exclusory.  The grading surgeon may well take into account other factors such as comorbidity, age, history and previous investigation results to help prioritise a particular referral.  The examples similarly are not necessarily prescriptive e.g. an elderly patient with severe ischemic heart disease and claudication may have a different priority from a postman with similar symptoms. 
  • Simple skin cancers are not considered "urgent" malignancies.
  • Varicose veins if meet primary care management guidelines
  • The waiting time criteria are to be seen as a guide to maximum wait - many 2As and 2Bs will be seen sooner rather than at the "maximum" wait time.  If patients cannot be seen within time then the referrer will be notified by administrative staff.


Last updated : Thursday, September 27, 2018
Next review date : Friday, September 27,2019


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.