Project Summaries

Rapid Changeover of patients in Theatre 8 (OG)

What problem are you setting out to solve?

As a patient in theatre I am expected to have my surgery done on the day as planned and not get cancelled, as this will add to my stress and anxiety. As a member of the Theatre team, we want to treat all patients on the list through a stress free day in theatre, maintaining efficiency and finishing on time. The Team are seeking to reduce the average changeover time between patients from 54 minutes to 30-40 minutes which would allow, in time, more patients to be treated on each list.

How do you intend to solve this?

The team held a mapping session before Christmas and identified a range of improvements to their Theatre practice including

  • The importance of scheduling a regular team in the Theatre to learn together
  • Collecting the next patient in good time and ensuring they are cannulated to reduce delay
  • Giving Recovery 15 mins early warning that the patient will be ready, allowing planning and reducing delays
  • Surgeon assisting the Anaesthetist in pushing the patient to Recovery so all the Scrub staff can clean down and prepare for the next patient on list
  • Anaesthetising the patient on the theatre table to reduce time in transferring the patient
  • Using appropriate drugs to wake the patient quickly so they can transfer themselves, on occasions, from the theatre table to trolley

What are you doing to improve this and how are you tracking progress? 

The team have been testing the changes since early December and collect their own daily data about changeover time as the list progresses. They also debrief each day. Learning is identified too through a weekly improvement huddle.

Flowchart

Changeover time graph

What difference has this made to patients? Please describe in relation to a patient journey

  • Patients are waiting less time on the day for their procedure
  • In time, we may be able to treat an additional patient on the list so patients should wait fewer weeks for surgery

What difference has this made to staff?

  • “Best day I’ve had in four years” (on the day when the changeover time for all patients on the list was less than 30 minutes each time)
  • Staff finishing the list between 4pm and 5pm and not running over
  • The staff are enjoying challenging themselves

Is this part of a wider programme of work? (i.e. e-Discharge Project)

  • Yes we are rolling this out steadily across all of Theatres
  • (We had a kick off session this week with Emergency Theatre 7)

Who is involved in your improvement team? Please give roles

  • Grant Sanders (Care Group Director, OG Surgeon) is the lead
  • All of the OG Surgeons (Tim Wheatley, Lee Humphrey et al)
  • Paula Woodhouse (Sister), Cindy McConnachie (Matron), Lisa Brodripp (Sister)
  • Recovery Team
  • Scrub Team (Nurses and HCAs)
  • Anaesthetists (Matt Ward, Matt Hill et al)
Updated 17 January 2020

What is the current state? This should be backed up by data relating to the problem

See the graph above showing before and after

Has there been any recent changes to the data, or significant steps taken to improve on the current process? Always ensure any changes in data are statistically significant and can be evidenced wherever possible

Yes downward trend – see above.

What stage of the improvement cycle are you / the team currently in? I.e. are you still trying to understand the root cause of the problem, are you trying PDSA cycles or are you embedding change practice following a series of tests?

The team are PDSA-ing the changes.

What are your learning points?

Power of teams driving improvement / value of team collecting own data / value of team mapping own process and identifying things they want to work on / value of benchmarking best practice outside of Trust

What are your next steps?

Explore whether additional patients can be added to list  / embed improvement huddle practice.

 

 

Name: Neil Hammacott

Role: Head of Improvement

Email: neil.hammacott@nhs.net                             

Tel: 01752 432730

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