TRAUMA THEATRE UTILISATION

Mr N CookeMr T FriesemCarol Bowler

Is it a National priority or a local priority?

YES

National Priority

NCEPOD An Age Old Problem (2010)

NICE Hip Fracture Guidelines CG124

NTHFT Priority

National Hip Fracture database ; additional income if we meet the best practice tariff criteria

Mortality and morbidity figures reflects quality of service

It is cost effective to deliver timely, appropriate, high quality care

Effective and efficient utilisation of theatre resources

Reduced length of stay

Goal

Better utilisation of theatre resource To achieve best practice tariff when

caring for elderly patients with neck of femur fracture

Improve patient experience and outcomes

Empower team Sustain change Identify future service developments

Changes required to lead to the improvement

Team approach Identify waste and defects Reduce waste and defects Measure effect of changes Review result of change

We used the LEAN methodology to help us achieve our goal. A variety of defects and waste were identified....

Booking forms not always completed

Current Paper booking forms

are not completed for all theatre patients in a timely manner

Forms are often inaccurate and delays arise

If booking forms are delayed then the theatre list is not produced and first case is delayed

Planned change Night shift theatre

staff check forms currently

Plan to pilot 2 electronic theatre booking systems once the theatre IT system has been upgraded.

Patient case notes not easily accessible

After Notes placed on

designed shelf in both ward areas

Results printed out and checklist introduced to ensure all test results were available and filed in casenotes

Now all patient notes will be found at patients bedside in wall mounted holders (further progress)

Before Patient case notes

not well organised Anaesthetist spent

valuable time looking for notes and relevant blood results ECG etc

Ward staff not available to escort patient to theatre

Before Theatre staff send

for patient Ward staff not

always available at 8-9am as ward busy and delays begin

Ward staff do not prepared 1st patient until they have a theatre list

After Ward staff prepare

1st patient for 8.30am

Theatre staff x 2 collect patient at 8.45am whenever possible

1st patient arrived in theatre and was held in waiting bay

Before First patient was

held in waiting bay which delayed anaesthetic

After Patient went

straight from ward into anaesthetic room

Anaesthetist and surgeon delayed on ward

Before Patient often waits

in theatre for arrival of anaesthetist and surgeon

After Surgeon and

anaesthetist arrive for brief at 9am

Measures

Savings

Better utilisation of theatre time Hip fracture patients treated in a timely

manner therefore BPT payment may apply if remaining criteria achieved

Reduced length of stay, reduced mortality and morbidity.

Better patient experience and improved outcomes

Future developments

Electronic theatre booking ; 2 systems to pilot planned for January and March

Access lounge will free up valuable time on ward during busy morning activities therefore 1st theatre case should always be prepared for prompt start.

Adoption of the NICE guidelines 124 for hip fracture patients

Team continues to strive to achieve excellence for all patients attending NTHFT.

What did we learn?

The course enabled the team to focus on how our roles, skills and mindsets can influence clinical practice and improve the patients experience and outcomes.

The Belbin self assessment and 360 degree feedback increased our self awareness and enabled us to identify areas where improvements can be made to our leadership skills.

We also learnt;

Patients and carers come first, last and always (K Jarrold).

Florence Nightingale recognised the importance of light, space, ventilation and single room accommodation to improve the health of her patients ( reading from A Foster).