OP E R ATING THEATR E S
Design/tailor and
implementation of procedure level clinical pathways
Fast Track Surgical Hubs
Re thinking roles and supporting the workforce
Develop/tailor 29 standardised surgical pathways, supported by the specialist societies and relevant Royal Colleges and sign off by the regional Clinical Advisory Group. Access best practice support e.g. National Day Surgery Delivery Pack.
Focus on clearing backlog at a system level developing hub sites which are COVID protected to ensure efficiency, high productivity and maximising patient safety. Access best practice support e.g. Cataract Hubs and High Flow Cataract Lists.
Support new ways of working to improve job satisfaction to work ‘smarter’ rather than ‘harder’ e.g. break down the tasks of the clinical teams against the standardised pathway, map them to clinical competencies and arrange rapid skills development to upskill clinical teams as well as distributing tasks to support staff.
Theatre principles and standards
Theatre productivity standards, e.g.10 cataracts on half day list; agreeing principles around start and finish times; standardising turnaround times between cases, and BAU expectation of day case rates at 85%. Develop day surgery as the default and challenge day surgery rates using benchmarking data.
System level data
Clinical leads
Setting the outcomes with clinicians at the top decile for clinical outcomes including developing a ‘gateway’ process centred on a clinically led, data driven discussion to challenge unwarranted variation at system level.
Establishing regional specialty clinical leadership groups (Specialty Advisory Groups or Expert Advisory Groups) to work with the system clinicians, supported by the national clinical leadership, to develop and deliver the changes.
Figure 1: Approach to elective recovery - GIRFT’s High Volume Low Complexity guide (May 2021)
are now 43. Croydon Health Services NHS Trust, for example, created a dedicated elective surgery fast track hub within their existing footprint and is running at 120% of pre-lockdown activity levels for routine procedures, such as cancer, cardiac and hip operations, making it among the top performers in the country.
The programme will be rolled out in phases, but a partnership with the independent sector will be required as the numbers are so vast. The impact of the ‘High Volume, Low Complexity’ programme will be measured, as part of the Model Hospital System, so metrics will be published on a monthly basis for all 29 pathways. Data will be available at National, regional, system
and individual Trust level. “The ‘High Volume, Low Complexity’ pathways will reduce waiting lists if we get it right,” he commented.
Importance of data
Comprehensive theatre data will be essential to assess the productivity of services, to identify spare capacity, opportunities for improvement, and to track progress. Fortnightly submissions of theatre data have now been mandated nationally, but compliance is still very poor in some regions. Therefore, a letter was sent out in July 2021 reiterating the need to submit this data. The independent sector has also agreed to provide their data for inclusion in the Model
Hospital System, allowing – for the first time – a comparison of NHS and independent sector productivity. Prof Briggs pointed out that the mandating of theatre productivity data returns from every Trust will be a “game changer” and there will be “nowhere to hide”. In conclusion, Prof Biggs said that we need to improve patient flows and maximise elective capacity at 130%-150% for ‘business as usual’. He warned delegates that we cannot default to pre-COVID behaviour, adding that “we must all own the problem”. The GIRFT methodology needs to be implemented; it is urgent, not optional; effective surgical pathways need to be adopted – thereby standardising care and outcomes; and Trusts need to produce performance at top decile as the norm. “I think there is a real chance we can deliver this. What we cannot do is stay as we are, however… Clinicians must step up to the plate,” he concluded.
‘In-sourcing’ to tackle waiting lists Dr. Matthew Molyneux and Dr. Neil Rasburn, directors of Glanso UK and consultant anaesthetists with the University Hospitals Bristol and Weston NHS, opened their presentation with the quote: “Houston we have a problem…”
Drawing on a comparison between the NHS and Apollo 13, they sought to demonstrate that ‘in-sourcing’ is the way forward to solving the crisis of the backlog. When Apollo 13 faced catastrophe, the solution was to use the collective knowledge
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Elective Recovery High Volume Low Complexity (HVLC) guide for systems (May 2021)
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