Theatre efficiency
Reforming elective care pathways
Following the publication of Mölnlycke’s report on recovering elective care in the UK, James Hockleydiscusses some of the key areas where operating theatre efficiencies can be delivered. He highlights how new ways of working could help to relieve pressure on the system and its staff.
In 2020, the NHS faced its largest challenge in its 72-year existence. The COVID-19 pandemic placed immense strain on the NHS, putting significant pressure over its workforce. Hospitals experienced an overwhelming influx of patients, necessitating rapid adaptation and expansion of healthcare facilities. Healthcare professionals, including doctors, nurses, and support staff, worked tirelessly to meet the escalating demands under challenging circumstances. Their actions prevented the system from collapsing during the worst of the pandemic, by prioritising resources to save the lives of those who had been acutely infected by the virus. This, combined with the slowdown of activities
in the system due to the lockdowns, has caused the NHS waiting list to hit new records.1,2
Despite
the hardships, the NHS workforce has continued delivering the best standards of care. The
efforts of healthcare practitioners working across the UK can be reflected in the available data, such as the number of patients waiting more than 18 months for elective care falling to just 10,737 by April 2023 (down by more than 90% from 124,911 in September 2021).3
Nonetheless,
the NHS’s capacity continues to be heavily strained, and urgent action is needed to reduce the elective care backlog and relieve pressure on the system and its staff.
Reforming elective care pathways Ultimately, by increasing operating theatre efficiencies, we can tackle the heart of the problem: by reducing hospitalisation times, clinicians will be able to help more patients in the same amount of time – a more efficient system is always a more productive one. With this in mind, Mölnlycke recently published a
report on recovering elective care in the UK. The report was developed following a roundtable held with clinicians, nurses, and representatives from leading professional organisations and think tanks. In the roundtable discussion, participants highlighted how COVID-19 broke down existing siloes across clinical teams, allowing staff to expand their clinical skills and patients to receive the right care more easily. One of the examples discussed was the need to explore new ways of thinking across the system, such as how simple changes to practice can allow greater flexibility. Efficiencies can be improved through many
different methods. For example, to maximise Trusts’ resources and ensure that surgeries are less affected by external circumstances, more attention should be given to day case surgeries. To enable this, the report recommends establishing guidelines on how efficiencies can be created in the health service by breaking down formal job roles and allowing staff to operate more flexibly. Participants argued that hospitals can adjust pathways to plan more effectively for elective care through actions such as shared decision-making with secondary care teams and group surgery schools. This ensures that examples of best practice can be widely shared among professionals in areas where efficiency is central, such as perioperative care. Indeed, evidence has confirmed the importance of this step of the surgical pathway; a June 2020 report by the Centre for Perioperative Care (CPOC) revealed that by preparing patients better before surgeries, the length of in-patient stays is reduced by an average of 1-2 days, and complication rates after surgery by 30-80%.4 One key aspect of this strategy is reducing
the rates of surgical site infections (SSIs). SSIs, which affect close to 5% of all patients undergoing surgery5
, can cost up to £100,000
per patient and increase hospital stays by weeks or even months. This means that prevention
September 2023 I
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