Download
1 / 64
640 likes | 643 Vues
Seamless Surgery Connect Day. Mr Chris Blundell FRCS( Tr&Orth ), MD Consultant Orthopaedic Surgeon. It started with a problem!. 2011.
E N D
Seamless Surgery Connect Day Mr Chris Blundell FRCS(Tr&Orth), MD Consultant Orthopaedic Surgeon
“The capacity (rooms, bays etc.) are not fit for purpose. It's a poor state of affairs when patients are sat on a corridor waiting to be seen. The waiting room needs to be more patient-friendly -need more space to see patients whilst maintaining their dignity” A member of Staff “The waiting area is very small and cramped without adequate seating for everyone. I’m surprised there aren’t more private facilities as some patients are in obvious discomfort and may be embarrassed” NGH TAU patient
“I feel a 4 hour wait is a little excessive, however I know there are patients here with a longer wait time than me. I know there must be a reason for the wait time but it would be nice to be told why” NGH TAU patient “Terrible patient experience (not due to staff) because of the environment, especially sitting in a small corridor” A member of Staff
“Atmosphere for patients awful - like Paddy's market - no space, production line, nowhere to see patients -make the patient experience better but help staff to do their job” A member of Staff “I arrived for 7am but there were no seats left which I found very uncomfortable. I was also worried about an elderly gentleman on crutches who was obviously struggling with the space and lack of seating” NGH TAU patient
Drivers for change • Staff
Drivers for change • Staff • Poor perceived patient experience • Not just at admission but • Start to finish
Drivers for change • Staff • Poor perceived patient experience • Start to finish • Inefficient theatre activity
Drivers for change • Staff • Poor perceived patient experience • Start to finish • Inefficient theatre activity • High list cancellations • Excessive delays / downtime
Drivers for change • Staff • Poor perceived patient experience • Start to finish • Inefficient theatre activity • High list cancellations • Excessive delays / downtime Demoralisedteam
Team for “Doing Something” • Sign up • “Management” • Senior support / Leadership • Data acquisition • Clerks / Admin team • Clinical Team • Surgical • Anaesthetic • Nursing – theatres, ward, out-patients
Patient feedback pre-improvement “Would have like to have been given some information on admission. Was sat in a corner with a curtain over and was wondering if I had been forgotten” “it seems ridiculous to come in at 7am for an afternoon operation.” “Did not know whether going home that day or staying overnight. Not sure about expected pain and expected medication.” “Letter was not clear; not clear which telephone number to ring” “Would like to see surgeon, would like to know outcome of today. People poorly on TAU (outliers) so felt a fraud on the ward.” “The staff in theatre made me feel at ease” . 7am when came in 2.30 before went to surgery. No communication given about the delay. Not told when to expect operation. Corridors and theatre freezing.
Team for change – 14 folk • Sign up • “Management” • Senior support / Leadership - 3 • Data acquisition - 1 • Clerks / Admin team / Secretarial – 3/4 • Clinical Team • Surgical - 1 • Anaesthetic - 1 • Nursing – theatres, ward, out-patients - 5
Main changes 1 • List planning • Right from start – timing of case to do when listed • Algorithm to plan list • Kit • Business planning meetings – times and kit confirmed at 2/52 in advance • Nurse from theatre attends • W/L coordinator attends • Adm time generated
Main changes 2 • Staggered admissions • Times driven on the list • Allow staff on TAU to prepare for theatre • “Incentivise” • Monitor progress real time
Main Changes 3 • Additional staff • PA to support Anesthetist • (£400pd expense vs additional case - £1500pd inc) • Increased block usage • Just in time admission • Continuous staff usage • Deliver patient 1 – Mark patient 3……
Patient 2 already arrived An room – PA preps OPERATING THEATRE Patient 1 Surgeon with HCA TAU Surgeon sees patient 3
Patient 2 operated PA supports OPERATING THEATRE TAU Anaesthetist sees patient 3
Main changes 2 • Times driven on the list • Allow staff on TAU to prepare for theatre • “Incentivise” • Monitor progress real time
Hard - Data Monitoring • Time from arrival to theatre and to start case • Time between cases • Start and finish times • Total cases done • Cancellations • Run chart data – look for variances, etc
“Do Something” team meetings • Weekly • Became alt weekly • 3 monthly • Annually • Less than annual now….
Team for changerarified for regular meetings 5 • Sign up • “Management” • Senior support / Leadership - 1 • Data acquisition - 1 • Clerks / Admin team / Secretarial – 1 • Clinical Team • Surgical - 1 • Anaesthetic - 1 • Nursing – theatres, ward, out-patients - 1
At one year after initial changesquestions re-asked Sample and re-sample data
Patient feedback post improvement “I was treated in a professional and friendly manner by all the staff – excellent” • “Was kept warm in theatre” “Absolutely happy - everyone was brilliant” “All okay - everyone really friendly and helpful” Seen straight away, the team in theatre were smashing, made me feel comfortable - couldn’t fault them. “Many thanks to everyone I came into contact with” “In general really good - but the environment on the admission unit is chaotic”
