1. Trauma theatre utilisation Mr N Cooke Mr T Friesem Carol Bowler

2. Is it a National priority or a local priority? YES

3. National Priority • NCEPOD An Age Old Problem (2010) • NICE Hip Fracture Guidelines CG124

4. 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

5. 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

6. 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....

7. 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.

8. 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

9. 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

10. 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

11. 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

12. Measures

13. 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

14. 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.

15. 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.

16. 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).