Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Summary
The purpose of this initiative is to reduce the number of patients on the neurosurgery waitlist while increasing access to neurosurgical care and enhancing patient outcomes through a nurse-led clinic.
Dates: March 2024 - Ongoing
Implementation sites: Princess Alexandra Hospital, Metro South Health
Aim
To reduce the neurosurgical waitlist by developing a model of nursing care that safely and effectively delivers expert neurosurgical nursing consultancy to patients who have been referred for neurosurgical opinion and management of various neurosurgical conditions.
Outcomes
The neurosurgery NEW waitlist has been reduced by 61% from a total of 780 to approximately 300 patients from March 2024 to December 2025.
The following cumulative number of patients have been seen in this nurse-led clinic since it's implementation :
- 1257 “New” patients directly from the neurosurgical waitlist
- 1804 “Review” patients who were previously new patients that require ongoing care or referred from various neurosurgical medical clinics. This nurse-led service has dramatically improved access to care for Metro South’s cohort of neurosurgical outpatients.
Background
In 2024, a temporary funding initiative was developed with the purpose of expanding the neurosurgery specialty outpatient department service. This was to address the long wait outpatient lists through innovative models of care improving throughput, timely patient treatment and access to care. This initiative was allocated funding of 1.0 FTE for clinical nursing hours (2 x 0.5 FTE) to enable the development of the neurosurgical nurse-led clinic. 0.5 FTE was also allocated for outpatient neurosurgical registrar time.
To date, the nurse led clinic has consulted 1257 new patients from the waitlist and 1804 review patients.
The growth of the service continues to deliver improvements in access to care for neurosurgical outpatients. An additional 568 patients were reviewed in 2025 by our nurse-led clinic in comparison to 2024. This data shows the nurse-led clinic is continuing to evolve and improve access to the neurosurgical outpatient cohort. The priority at the commencement of this role was to address the long waits and breached waiting times for all triaging categories.
This requires regular review and action due to the constant flow of incoming referrals. For example, at the outset, the longest waiting category 1 patient was waiting 752 days for an initial outpatient neurosurgical appointment. Patient access to the outpatient neurosurgical service was a lengthy and frustrating process, often resulting in poor patient outcomes and increasing ED presentations. In collaboration with the neurosurgical medical team, a pathway was developed as a tool to support the nurse-led model of care.
Methods
Model for Improvement and Plan Do Study Act (PDSA) cycle:
Plan:
- The successful applicants of the role would require an extensive neurosurgical knowledge base and an established rapport with the neurosurgical medical team to facilitate trust and open communication.
- Understanding of outpatient processes was key to ensuring the successful implementation of the clinic. An opportunity to be mentored by the nursing team in specialty outpatients was key in understanding and adapting to the significant process change and priorities from an inpatient service to an outpatient service.
- In collaboration with the neurosurgical director, a framework was developed in which neurosurgical nursing consultancy could be safely delivered to patients.
- A template was created for the nurse-led bookshelf on ESM to support the clinic needs and to guide administration staff when booking patients to the neurosurgery nurse-led clinic.
Do:
Working group to establish specific processes to support our clinic. The initial goal was to find patients appropriate for the nurse-led clinic. This was achieved by:
- Starting with the longest wait times per category, every patient on the neurosurgical waitlist was discussed with a neurosurgical consultant to ascertain whether the patient was suitable to be seen in the neurosurgery nurse-led clinic.
- Patients from various neurosurgery consultant clinics were discussed with the consultant and if appropriate, flipped to the nurse-led clinic.
- Patients appropriate for nurse-led clinic: the neurosurgery consultant gave the clinical nurse clear directives with safety netting advice. This usually included contacting the patient, discussing history and symptoms, organising updated imaging and giving education to the patient and GP.
- Patients not appropriate for nurse-led clinic: unfortunately, these patients remained on the waitlist for the next available registrar/ consultant clinic.
Study/Review:
- The process of discussing each patient with a consultant was time consuming and heavily dependent on neurosurgery consultant time thus impacting the number of patients being seen in the nurse-led clinic.
- Initially patients were being “cold called” from the waitlist without prior booking in ESM. The realisation came that patients wouldn’t pick up an AD HOC phone call from a private number. By partnering with the administration team in speciality outpatients and their usual booking practices, a letter of appointment was posted and a text message sent so the patient could anticipate a private number calling.
Act:
- Patients from the neurosurgery waitlist appropriate for the neurosurgery nurse-led clinic are now directly triaged to our clinic by the director of neurosurgery. This negated the need for timely nurse-to-consultant meetings to review each individual patient and streamlined the process allowing for optimisation of resources in a safe and timely manner.
- The creation of a nurse-led neurosurgery condition pathways in collaboration with the neurosurgical team for certain neurosurgical conditions streamlined processes whereby the clinical nurse consultant can now organise imaging and review prior to discussion with the neurosurgical consultant.
- The nurse-led clinic has capacity to accept patients from various neurosurgical medical outpatient clinics with a plan documented in ESM (ex: chase/organise imaging, reassure patient of stability and follow up plan).
Discussion
Keys to success:
- The fundamental requirement for this project to succeed was an open and willing team of neurosurgeons, developing trust with the patient cohort, and support from the specialty outpatient nurses and administration team.
- Clear discussion with patients about the purpose of the neurosurgery nurse-led clinic and the reassurance
of being able to see a neurosurgeon should they require surgical intervention, their condition changes or should this be their preference. - Patient focus: longer appointment times with the ability to provide care, compassion and education when compared to neurosurgery medical clinics.
- Patient safety measures to ensure escalation to appropriate neurosurgery registrar/consultant while within the nursing scope of practice.
Lessons Learnt:
- Initial reluctance from some neurosurgical staff, yet over-trusting and expectations beyond the nursing scope of practice with others. This was navigated by discussing clear expectations about which patients are appropriate for the nurse-led clinic to align with the scope of practice for the clinical nurse consultant.
- Interestingly, most patients were grateful to be seen by the nurse-led clinic. There was anticipation of push back from patients who were waiting to see a neurosurgeon but instead were triaged to see a neurosurgical nurse.
- Initial time required by neurosurgeons for care planning. This has since been streamlined and optimised.
- Initial communication with the administration staff in specialty outpatients. There is now a clear template on ESM for admin to book patients into our clinic.
Strengths:
- Support from neurosurgical consultants, registrars, residents, the specialty outpatient nursing and administration teams along with the specialty outpatient nurse unit manager and assistant nursing director.
- This role started as a Grade 6, clinical nurse role and through the support of nursing management who have seen the scope and value, it has been upgraded to a Grade 7, clinical nurse consultant role.
- The neurosurgical nurse-led clinic requires a highly skilled clinician who works autonomously under clear safety frameworks to ensure effective patient care is delivered.
Opportunities:
- Since the commencement of the neurosurgery nurse-led clinic, there has been collaboration with the neurology department who have also been discussing ways in which to address their waitlists. Open to benchmarking with other services to assist in achieving results.
- There is potential within many streams of healthcare where this model of nursing can be implemented to safely and effectively address the waitlists and breached wait times, ultimately improving patient care while reducing the patient load on medical clinicians
Next steps:
- Create a patient feedback form to partner with consumers and continue to assess and improve the service. There has been subjective positive feedback thus far from the patients reviewed in this clinic, but this has yet to be formally captured.
- Create more efficiencies within the nurse-led clinic to streamline care and increase the number of patient throughput.
- Present the outcomes throughout Queensland Health and beyond to benchmark with other similar services and to assist with the creation of similar nurse-led clinics.
- Work towards securing permanent funding to ensure this nurse-led clinic remains an integral part of the neurosurgery outpatient team.
Our customers – the Townsville Oral Health Services – were the proud recipients of a regional “Embracing Innovation Award” that further demonstrates the value their HHS places on the outcomes of the project.
References
Model for Improvement and PDSA cycles. New South Wales Government- Clinic Excellence Commission. https://www.cec.health.nsw.gov.au/CEC-Academy/quality-improvement-tools/model-for-improvement-and-pdsa-cycles
Key contact
Emily Roy
Neurosurgery CNC Specialty Outpatients Planned Care
Princess Alexandra Hospital