Elective surgery recovery
The Trust has also implemented extra support for patients that need an extra level of care post-surgery – which has included the design of a post-anaesthetic care unit (PACU), at the Halton site. A collaborative approach has also been key and has involved the following stakeholders: l Associate director – planned care. l RTT team. l CBU/assistant CBU managers. l Waiting list teams. l OPD/clinics. l Preoperative assessment team. l Theatres. l Wider hospital team – for example: cardiorespiratory for appointments/results for ECHO, 24-hour tape, Pulse oximetry, Lung function test etc.
l Transformation team.
The target now is to tackle the 65-week waiting patient cohort by the end of March 2024, in line with the NHS England mandate. The long waiters dashboard now shows the 65-week and 52-week waiting patient cohorts. The next steps are to work collaboratively with the Cheshire and Merseyside Integrated Care Board (ICB) and network to share best practice, increase day case activity, implement Getting it Right First Time (GIRFT) pathways/High Volume Low Complexity (HVLC) lists, and aim to identify and move cases from theatres into clinical treatment rooms where possible. Collaborating with the Cheshire & Merseyside network, the Trust has now signed up to the Theatre Academy and Model Hospital benchmarking, and is initially focusing on late starts, list utilisation and productivity.
Getting it Right First Time Dan Pearce, NHS England, went on to discuss the contributions of GIRFT in improving outcomes, tackling the backlog, and increasing efficiency. The programme was first conceived and developed by Professor Tim Briggs to review elective orthopaedic surgery to address a range of observed and undesirable variations in orthopaedics. In the 12 months after the pilot programme, it delivered an estimated £30m-£50m savings in orthopaedic care – predominantly through changes that reduced average length of stay and improved procurement. The programme undertakes clinically led
reviews of specialties, combining wide-ranging data analysis with the input and professional knowledge of senior clinicians to examine how things are currently being done and how they
could be improved. Part of an aligned set of programmes within NHS England, GIRFT has the backing of the Royal Colleges and professional associations, and now covers 42 specialties.
Other important initiatives include the National Theatre Programme. There are five workstreams within the national programme: l Outstanding theatre teams: developing new roles and how skills mix can support local theatre teams to improve recruitment, retention, and staff wellbeing.
l Theatre productivity: improving theatre booking and scheduling and effective flow on the day to minimise avoidable delays for patients.
l Surgical hubs: using the outputs of the theatre programme to embed top decile working in all hubs.
l Right procedure, right place: Building on work started during COVID, supporting providers in moving procedures to the most appropriate setting, from traditional theatres to outpatient and community settings.
l Data driven change: Improving theatre metrics to support systems in identifying where challenges are in their theatre pathways to allow targeted solutions to be deployed at pace.
“When I started in 2021, I recognised that we didn’t have a National Theatre Programme in NHS England and there was a gap, particularly given the challenges presented by COVID and the need for elective recovery. We needed to make sure we were supporting theatres, from a performance point of view but also in sharing best practice,” he explained. Operations should be caried out as day case
procedures, where possible. However, where appropriate and safe to do so, procedures
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