Surgical hubs
electives for beds related pressures. So, we wouldn’t put emergency patients into elective bed capacity. The only reason we would ever need to cancel is if the patient isn’t fit or there’s an unexpected issue with equipment, for example. However, as a rule, we would never cancel electives, even in winter, and that’s why it makes sense to put the Vanguard (theatre) closer to the ward, because we know we’re not going to be using it for anything else anyway.” Maximising productivity is key to the success
of a surgical hub and to addressing the nation’s backlog in elective surgery, and exclusively using the resources for the surgical hub is one of several ways in which South Warwickshire University NHS Foundation Trust maximises efficiency. It was possible to create the elective hub within weeks because the laminar flow theatre is a mobile facility provided by Vanguard Healthcare Solutions, linked to the hospital by a specially constructed corridor. Harkamal explains how deciding where the
theatre is located was important: “We built a corridor right off the orthopaedic elective ward and it really does improve the patient journey. Patients can visualise where they’re going, and that journey is just a lot more streamlined. Every micro gain that you can make in any kind of theatre pathway really adds to the productivity and the overall efficiency.” Multiple benefits come from this. Harkamal continues, “That’s why we’ve made the decision to put the theatre there. So far, we haven’t lost a single joint. We don’t overrun, so, the staff experience is much better. We start on time. That’s obviously better for staff and patients. So, it makes sense to try and do as much close to the patient, as you can.” Harkamal recognises that staff responsible for patient management play a key role in ensuring the theatre is fully utilised: “We’re good at that here, you know, our T&O booking
We know that people can live between 16 and 20 years in ill-health in this area and that has a real cost and a real impact on our local economy. So, helping people get their operations sooner, get mobilised sooner, get back to work or get back to not needing quite so much support, feels really important, and trying to reduce time spent in ill-health
is absolutely a driver for us. Harkamal Heran, South Warwickshire University NHS Foundation Trust.
list, and we manage them in the exact same way that we would ordinarily.” Length of stay has obvious implications for
Harkamal Heran, (left), and Glen Burley, (right), either side of Chris Blackwell-Frost, CEO, Vanguard Healthcare Solutions.
team, for example, are excellent. They’ve been validating all the way down. We know exactly what’s happening with our patients. We know when they are ready to be here. We know if they have anything coming up that we need to work around. That’s really important and has been really key to us maximising our lists. “We have had, in the last couple of weeks, patients not being very well but we have a whole group of patients who are ready to come in at short notice. We ring them in the morning and then they come in. Therefore, we haven’t lost a single opportunity to operate since the Vanguard (theatre) has been here, and we’ve just adopted the same approach for patients that we offer mutual aid to. We add them to our
productivity. Consultant Orthopaedic Surgeon, Tim Robertson says that a joint replacement is increasingly a day case, and that length of stay is consequently shortening. As well as the positive impact of freeing up beds, this also benefits patients. Harkamal says, “As soon as you are operated on, you want to go home and start your rehab journey. We are looking to see what more we can do in terms of any additional cases and that’s starting to ramp up already because we know that we can create the bed capacity to bring more patients in, as and when appropriate. It’s about optimising the pre-op and then the post-op rehab, and getting patients home is a really, very key part of that.” Tim comments. “Historically, we’ve had what we call our SWATT, which is our South Warwickshire Accelerated Transfer Team – a team of nurses and physios who have been able to take patients out from hospital earlier and when necessary, go and see them at home, phone them up and manage all of that. If you have complications, generally we would like patients who have a problem after surgery to be getting in touch with us rather than their GP.
I think that’s good for us, it’s good for the patient, and it’s pretty good for the GP as well.” Vital to productivity and to the quality of
the care, are the working environment and the clinical team. The core element of the elective hub at South Warwickshire University NHS Foundation Trust is the mobile laminar flow operating theatre, provided by Vanguard Healthcare Solutions. Tim has worked in similar theatres four
The inside of the Vanguard laminar flow theatre
times previously and described what it is like to operate in one: “Basically, it’s pretty easy. I think the most obvious difference is that they’re smaller than a modern, full size operating theatre. Although, I think in my time,
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