seamless surgery connect...adjusted in-hospital mortality or stroke rate of patients undergoing a...

@seamlesssurgery #seamlessconnect18

Seamless Surgery Connect

Friday 23rd March 2018, 09:15 - 16:00

@seamlesssurgery #seamlessconnect18

@seamlesssurgery #seamlessconnect18

Welcome & Introduction

Miss Fiona Kew Clinical Director – Obstetrics, Gynaecology & Neonatology

and Clinical Lead for Seamless Surgery

Sheffield Teaching Hospitals NHS FT

@seamlesssurgery #seamlessconnect18 Agenda

Time Item Location

09:15-10:00 Arrival, registration, & coffee Postgrad Common Room

10:00-10:10 Introduction Miss Fiona Kew

Lecture Theatre

10:10-10:45 Seamless Surgery – Our Story Lecture Theatre

10:45-11:30 Breakout 1 Breakout Rooms

11:30-12:00 Mr Chris Blundell Lecture Theatre

12:00-12:45 Lunch Postgrad Common Room

12:45-13:30 Professor Mike Horrocks & Liz Lingard (GIRFT)

Lecture Theatre

13:30- 14:00 Professor Tom Downes Lecture Theatre

14:00-14:45 Breakout 2 Breakout Rooms

14:45-15:00 Coffee Postgrad Common Room

15:00-15:45 Breakout 3 Breakout Rooms

15:45-16:00 Reflections & Close Lecture Theatre

@seamlesssurgery #seamlessconnect18 Who’s here?

@seamlesssurgery #seamlessconnect18 Who's here?

@seamlesssurgery #seamlessconnect18

@seamlesssurgery #seamlessconnect18

Seamless Surgery – Our Story Paul Griffiths

Seamless Surgery Programme Manager

Dr Karl Brennan

Consultant in Neuroanaesthesia & Neurocritical Care

and Clinical Lead for Seamless Surgery

Sheffield Teaching Hospitals NHS FT

@seamlesssurgery #seamlessconnect18

“There should be much more emphasis on bringing about

improvement and change from within”

@seamlesssurgery #seamlessconnect18 Making connections

make 2 new connections….

share something about yourself… …and what motivated you to be here today

In 2 minutes

@seamlesssurgery #seamlessconnect18

9 million

Elective operations across the NHS in England per year

@seamlesssurgery #seamlessconnect18

414 million

Patient days spent waiting for surgery

@seamlesssurgery #seamlessconnect18

88%

Improvement in patient health as a result of a hip replacement

(PROMS Score, 2017)

@seamlesssurgery #seamlessconnect18

189

Reported wrong site surgery incidents in 2016/17 across the NHS in England

@seamlesssurgery #seamlessconnect18

90,000

Cancelled operations across the NHS in England per year - with a cost of around £180m

@seamlesssurgery #seamlessconnect18

20%

Proportion of the NHS budget spent on elective surgical care

@seamlesssurgery #seamlessconnect18

2012

@seamlesssurgery #seamlessconnect18

@seamlesssurgery #seamlessconnect18

@seamlesssurgery #seamlessconnect18

Spread it…

…at scale and at pace

@seamlesssurgery #seamlessconnect18

@seamlesssurgery #seamlessconnect18

@seamlesssurgery #seamlessconnect18

22

@seamlesssurgery #seamlessconnect18

What is Seamless Surgery?

@seamlesssurgery #seamlessconnect18

“Continuous improvement work and projects, led by front line teams, using

improvement methodology. It is underpinned by principles of good practice,

with the aim of creating the best elective surgical pathways for all of our patients”

@seamlesssurgery #seamlessconnect18

“If you want to make true and lasting change ask the people who do the work”

Daren Anderson, MD VP/Chief Quality Office

Community Health Centre, Inc.

@seamlesssurgery #seamlessconnect18

Subject Matter Knowledge

Subject Matter Knowledge …of the basic to the things we do in life; professional knowledge.

Profound Knowledge …the interaction of the theories of systems, variation, knowledge, and psychology.

Profound Knowledge

How we do it…

@seamlesssurgery #seamlessconnect18

Profound Knowledge

Subject Matter Knowledge

Improvement

@seamlesssurgery #seamlessconnect18 Deming’s Lens of Improvement

@seamlesssurgery #seamlessconnect18

@seamlesssurgery #seamlessconnect18

Deming’s System of Profound Knowledge

@seamlesssurgery #seamlessconnect18

@seamlesssurgery #seamlessconnect18

Impact…?

@seamlesssurgery #seamlessconnect18

1800 more patients over 18 months

@seamlesssurgery #seamlessconnect18

@seamlesssurgery #seamlessconnect18

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Ap

r-1

7

May

-17

Jun

-17

Jul-

17

Au

g-1

7

Sep

-17

Oct

-17

No

v-1

7

Dec

-17

Jan

-18

% Within 18 weeks National v STH

% within 18 weeks (National) % within 18 weeks (STH)

Seamless Surgery Launch

20% reduction in median waiting times for surgery

@seamlesssurgery #seamlessconnect18

-£2,000,000.0

-£1,500,000.0

-£1,000,000.0

-£500,000.0

£0.0

£500,000.0

£1,000,000.0

£1,500,000.0A

pr-

15

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

Ap

r-1

7

May

-17

Jun

-17

Jul-

17

Au

g-1

7

Sep

-17

Oct

-17

No

v-1

7

De

c-1

7

Jan

-18

Feb

-18

Elective inpatient monthly income - variance against target

Income over-performance of £160k per month, from losses

of -£500k per month

@seamlesssurgery #seamlessconnect18

Feedback and the future…

@seamlesssurgery #seamlessconnect18

Pt Agrees Date

Production Control

Alturos

Fixed List 48hrs ePAQ-PO

Cancellation RCA

ORMIS 2 Wks

Core Th Team Th Flow

Escalation plans

Electronic Diaries

Reminder Calls

0.00

10.00

0 10Fully

Implemented Not Implemented

at all

Not Important

at all

Vitally

Important 158 Responses from 24 different

specialties/areas and 9 staff groups

@seamlesssurgery #seamlessconnect18

‘Huge improvement in understanding processes, working across directorates,

better communication, better understanding of one another's roles. Has created a value to

the operating services resource’

‘Lack of capacity in system will obstruct flexibility required to implement’

‘Implementation takes a long time’

‘Have finally reduced the number of on the day

cancellations’

‘It has greatly improved the running of lists on the day through

advanced planning’

‘Increased support to teams to make improvements, especially those finding it most difficult’

@seamlesssurgery #seamlessconnect18

Pt Agrees Date

Production Control

Alturos

Fixed List 48hrs ePAQ-PO

Cancellation RCA

ORMIS 2 Wks

Core Th Team Th Flow

Escalation plans

Electronic Diaries

Reminder Calls

4

6

8

10

4 6 8 10Fully

Implemented

Vitally

Important

@seamlesssurgery #seamlessconnect18

Leadership and Management Development

Organisational Development

@seamlesssurgery #seamlessconnect18

@seamlesssurgery #seamlessconnect18

Thank You – Any Questions?

@seamlesssurgery #seamlessconnect18

Now: Breakout 1

Breakout Room

Seamless Surgery in Sheffield – Sheffield Teaching Hospitals Postgraduate

Common Room

Reducing Surgical Site Infections & Improved Patient

Experience – St Georges Seminar Room 3

Seamless Surgery in Ophthalmology – Sheffield Teaching

Hospitals Seminar Room 4

Elective Care Team Sustainability Assessment Tool - NHSI Seminar Room 5

Well Prepared Surgery – Sheffield Children's Seminar Room 6

@seamlesssurgery #seamlessconnect18

Lunch Postgraduate Common Room

& Lobby Area @seamlesssurgery #seamlessconnect18

After Lunch: Liz Lingard & Professor Mike Horrocks from GIRFT in Lecture Theatre 2

Proportion of patients readmitted in an emergency within 30 days

for any reason following an AAA procedure by provider and

provider type: initial admission 01-Apr-2012 to 31-Dec-2014

66

EVAR procedure Open procedure

In-hospital mortality following any AAA repair procedure by

provider and provider type 01-Jan-2015 to 31-Dec-2015

67

(x10 variation)

Proportion of patients receiving a CEA procedure of any type within 7 days of referral to a Vascular service by provider and provider type 01-Jan-2014 to 31-Dec-2014

(x6 variation)

Median days from assessment to surgery for CEA repair by provider and provider type 01-Jan-2014 to 31-Dec-2014

(5-30 days variation)

Proportions of post-surgical destination ward type post CEA

procedure by provider 01-Jan-2014 to 31-Dec-2014

70

Adjusted in-hospital mortality or stroke rate of patients undergoing a CEA procedure during the inpatient spell of the procedure by provider and provider type 01-Jan-2014 to 31-Dec-2014

(x10 variation)

Adjusted in-hospital mortality or stroke rate of patients undergoing a CEA procedure during the inpatient spell of the procedure by provider and provider type 01-Jan-2014 to 31-Dec-2014

(x10 variation)

Adjusted in-hospital mortality or stroke rate of patients undergoing a CEA procedure during the inpatient spell of the procedure by provider and provider type 01-Jan-2014 to 31-Dec-2014

(x10 variation)

Activity counts of lower limb revascularisation procedures by procedure type, provider and provider type 01-Apr-2014 to 31-Mar-2015

Average length of stay for elective lower limb bypass procedures by provider and provider type 01-Apr-2014 to 31-Mar-2015

Diabetic Non-diabetic

Average length of stay for elective lower limb bypass procedures

by provider and provider type 01-Apr-2014 to 31-Mar-2015

74

- twice as long if admitted as an emergency

Non-diabetic Diabetic

Recommendations

• Engage of profession with management

• Fully develop the Network Structure (for Vascular)

• Develop as an Urgent Specialty with fast through flow

• Engage with Spoke hospitals, clinicians and managers

• Ensure all patients have same priorities

• Share pathways and timelines with other teams

• Adequate staffing and facilities

• Consider 7 day operating with cases fed into facilities

• Arrange angioplasties to reflect the urgency and facilities

Continued

• Full pre-admission work-up

• Prehabilitation where possible

• Early discharge planning

• Identify likely re-admitters (frailty score)

• Early medical contact post-op

• Phone contact for worried patients

• Review your litigation cases and learn from them

Local Issues

• Hubs, how many and where

• Combining teams

• Particular geographical problems

• Ensuring spokes are on board

• Shared pre-op work-up

• Accept post-op transfers

• Ensure links for referrals and MDT’s

• Regular reviews of data and outcomes

Questions

78

Mike Horrocks

GIRFT Vascular Clinical Lead

GIRFT Clinical Ambassador for South West Hub

E

M

Liz Lingard

North East, North Cumbria & Yorkshire Hub Director

E Liz.Lingard@nhs.net

M 07730374650

@seamlesssurgery #seamlessconnect18

Great care is discovered, not decided

Professor Tom Downes

Clinical Lead for Quality Improvement

Consultant Physician and Geriatrician

Sheffield Teaching Hospitals NHS FT

@seamlesssurgery #seamlessconnect18 Learning from failure

@seamlesssurgery #seamlessconnect18 Pyjamas

@seamlesssurgery #seamlessconnect18 20% reduction in LOS

@seamlesssurgery #seamlessconnect18 George

@seamlesssurgery #seamlessconnect18 Reduced hospitalisation of 40,000 bed days

@seamlesssurgery #seamlessconnect18 Sepsis

Proportion of all AAA procedures that are repaired by EVAR by

provider and provider type 01-Apr-2014 to 31-Mar-2015

64

Proportion of Aneurysms repaired by EVAR

65

Proportion of all unruptured (elective) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015

(x2 variation)

Proportion of all ruptured (emergency) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015 (x10 variation)

Proportion of patients readmitted in an emergency within 30 days

for any reason following an AAA procedure by provider and

provider type: initial admission 01-Apr-2012 to 31-Dec-2014

66

EVAR procedure Open procedure

In-hospital mortality following any AAA repair procedure by

provider and provider type 01-Jan-2015 to 31-Dec-2015

67

(x10 variation)

Proportion of patients receiving a CEA procedure of any type within 7 days of referral to a Vascular service by provider and provider type 01-Jan-2014 to 31-Dec-2014

(x6 variation)

Median days from assessment to surgery for CEA repair by provider and provider type 01-Jan-2014 to 31-Dec-2014

(5-30 days variation)

Activity counts of lower limb revascularisation procedures by procedure type, provider and provider type 01-Apr-2014 to 31-Mar-2015

Average length of stay for elective lower limb bypass procedures by provider and provider type 01-Apr-2014 to 31-Mar-2015

Diabetic Non-diabetic

Average length of stay for elective lower limb bypass procedures

by provider and provider type 01-Apr-2014 to 31-Mar-2015

74

- twice as long if admitted as an emergency

Non-diabetic Diabetic

Recommendations

• Engage of profession with management

• Fully develop the Network Structure (for Vascular)

• Develop as an Urgent Specialty with fast through flow

• Engage with Spoke hospitals, clinicians and managers

• Ensure all patients have same priorities

• Share pathways and timelines with other teams

• Adequate staffing and facilities

• Consider 7 day operating with cases fed into facilities

• Arrange angioplasties to reflect the urgency and facilities

Continued

• Full pre-admission work-up

• Prehabilitation where possible

• Early discharge planning

• Identify likely re-admitters (frailty score)

• Early medical contact post-op

• Phone contact for worried patients

• Review your litigation cases and learn from them

Local Issues

• Hubs, how many and where

• Combining teams

• Particular geographical problems

• Ensuring spokes are on board

• Shared pre-op work-up

• Accept post-op transfers

• Ensure links for referrals and MDT’s

• Regular reviews of data and outcomes

Questions

78

Mike Horrocks

GIRFT Vascular Clinical Lead

GIRFT Clinical Ambassador for South West Hub

E

M

Liz Lingard

North East, North Cumbria & Yorkshire Hub Director

E Liz.Lingard@nhs.net

M 07730374650

@seamlesssurgery #seamlessconnect18

Great care is discovered, not decided

Professor Tom Downes

Clinical Lead for Quality Improvement

Consultant Physician and Geriatrician

Sheffield Teaching Hospitals NHS FT

@seamlesssurgery #seamlessconnect18 Learning from failure

@seamlesssurgery #seamlessconnect18 Pyjamas

@seamlesssurgery #seamlessconnect18 20% reduction in LOS

@seamlesssurgery #seamlessconnect18 George

@seamlesssurgery #seamlessconnect18 Reduced hospitalisation of 40,000 bed days

@seamlesssurgery #seamlessconnect18 Sepsis

Proportion of all AAA procedures that are repaired by EVAR by

provider and provider type 01-Apr-2014 to 31-Mar-2015

64

Proportion of Aneurysms repaired by EVAR

65

Proportion of all unruptured (elective) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015

(x2 variation)

Proportion of all ruptured (emergency) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015 (x10 variation)

Proportion of patients readmitted in an emergency within 30 days

for any reason following an AAA procedure by provider and

provider type: initial admission 01-Apr-2012 to 31-Dec-2014

66

EVAR procedure Open procedure

In-hospital mortality following any AAA repair procedure by

provider and provider type 01-Jan-2015 to 31-Dec-2015

67

(x10 variation)

Proportion of patients receiving a CEA procedure of any type within 7 days of referral to a Vascular service by provider and provider type 01-Jan-2014 to 31-Dec-2014

(x6 variation)

Median days from assessment to surgery for CEA repair by provider and provider type 01-Jan-2014 to 31-Dec-2014

(5-30 days variation)

Proportions of post-surgical destination ward type post CEA

procedure by provider 01-Jan-2014 to 31-Dec-2014

70

Proportion of all AAA procedures that are repaired by EVAR by

provider and provider type 01-Apr-2014 to 31-Mar-2015

64

Proportion of Aneurysms repaired by EVAR

65

Proportion of all unruptured (elective) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015

(x2 variation)

Proportion of all ruptured (emergency) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015 (x10 variation)

Proportion of patients readmitted in an emergency within 30 days

for any reason following an AAA procedure by provider and

provider type: initial admission 01-Apr-2012 to 31-Dec-2014

66

EVAR procedure Open procedure

In-hospital mortality following any AAA repair procedure by

provider and provider type 01-Jan-2015 to 31-Dec-2015

67

(x10 variation)

Proportion of patients receiving a CEA procedure of any type within 7 days of referral to a Vascular service by provider and provider type 01-Jan-2014 to 31-Dec-2014

(x6 variation)

Proportions of post-surgical destination ward type post CEA

procedure by provider 01-Jan-2014 to 31-Dec-2014

70

Adjusted in-hospital mortality or stroke rate of patients undergoing a CEA procedure during the inpatient spell of the procedure by provider and provider type 01-Jan-2014 to 31-Dec-2014

(x10 variation)

Adjusted in-hospital mortality or stroke rate of patients undergoing a CEA procedure during the inpatient spell of the procedure by provider and provider type 01-Jan-2014 to 31-Dec-2014

(x10 variation)

Activity counts of lower limb revascularisation procedures by procedure type, provider and provider type 01-Apr-2014 to 31-Mar-2015

Average length of stay for elective lower limb bypass procedures by provider and provider type 01-Apr-2014 to 31-Mar-2015

Diabetic Non-diabetic

Average length of stay for elective lower limb bypass procedures

by provider and provider type 01-Apr-2014 to 31-Mar-2015

74

- twice as long if admitted as an emergency

Non-diabetic Diabetic

Recommendations

• Engage of profession with management

• Fully develop the Network Structure (for Vascular)

• Develop as an Urgent Specialty with fast through flow

• Engage with Spoke hospitals, clinicians and managers

• Ensure all patients have same priorities

• Share pathways and timelines with other teams

• Adequate staffing and facilities

• Consider 7 day operating with cases fed into facilities

• Arrange angioplasties to reflect the urgency and facilities

Continued

• Full pre-admission work-up

• Prehabilitation where possible

• Early discharge planning

• Identify likely re-admitters (frailty score)

• Early medical contact post-op

• Phone contact for worried patients

• Review your litigation cases and learn from them

Local Issues

• Hubs, how many and where

• Combining teams

• Particular geographical problems

• Ensuring spokes are on board

• Shared pre-op work-up

• Accept post-op transfers

• Ensure links for referrals and MDT’s

• Regular reviews of data and outcomes

Questions

78

Mike Horrocks

GIRFT Vascular Clinical Lead

GIRFT Clinical Ambassador for South West Hub

E

M

Liz Lingard

North East, North Cumbria & Yorkshire Hub Director

E Liz.Lingard@nhs.net

M 07730374650

@seamlesssurgery #seamlessconnect18

Great care is discovered, not decided

Professor Tom Downes

Clinical Lead for Quality Improvement

Consultant Physician and Geriatrician

Sheffield Teaching Hospitals NHS FT

@seamlesssurgery #seamlessconnect18 Learning from failure

@seamlesssurgery #seamlessconnect18 Pyjamas

@seamlesssurgery #seamlessconnect18 20% reduction in LOS

@seamlesssurgery #seamlessconnect18 George

@seamlesssurgery #seamlessconnect18 Reduced hospitalisation of 40,000 bed days

@seamlesssurgery #seamlessconnect18 Sepsis

@seamlesssurgery #seamlessconnect18 Discovered by staff from within

@seamlesssurgery #seamlessconnect18 CPD Credits

• Seamless Surgery Connect has been approved by the Federation of the Royal Colleges of Physicians of the United Kingdom for 5 external CPD credits.

• Please contact Rachael Keegan rachael.keegan@sth.nhs.uk if you would like a certificate of attendance emailing to you.