Great Ormond Street Hospital NHS Trust

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Great Ormond Street Hospital NHS Trust
Improving Access to PICU for Elective
Surgery Tracy Parr Improvement
Facilitator parrt_at_gosh.nhs.uk April 2007
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Great Ormond Street Hospital NHS Trust

• Tertiary Childrens Hospital
• 353 In-patient beds
• 8 Operating theatres
• 34 Intensive Care beds (PICU/NICU/CCC)
• 41 Wards - large range of surgical specialities
• General and neonatal surgery
• ENT/Plastics/Cleft
• Neurosurgery/Craniofacial
• Urology
• Orthopaedic and spinal
• Maxillofacial/dental
• Population characterised by children with
  multiple disabilities and co-morbidities

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Great Ormond Street Hospital NHS Trust

• Issues
• Senior managers away day identified cancellation
  of surgery due to lack PICU bed as top priority
  for the hospital
• First approach obtain descriptive data
• 10 month period 53 cancelled operations as no
  PICU bed
• Massive impact on families planning for post op
  course

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Pre-Admission/Pre-assessment
Great Ormond Street Hospital NHS Trust
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Great Ormond Street Hospital NHS Trust
Variability of emergency admissions to PICU June
2004 Jan 2005
Variability of elective admissions to PICU June
2004 Jan 2005
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Great Ormond Street Hospital NHS Trust
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Great Ormond Street Hospital NHS Trust

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Great Ormond Street Hospital NHS Trust
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Great Ormond Street Hospital NHS Trust

•  Highly predictable population - attempted to
  reduce variation in elective admissions
• Multiple specialties
• Part time consultants
• Little flexibility

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Great Ormond Street Hospital NHS Trust

• Examined threshold for booking PICU bed
• Low historic threshold perceived as being needed
  for safety
• Only 38 of booked and available beds for
  elective surgery used wastage of staffed PICU
  beds
• Agreement to raise threshold and only book beds
  for
• Children in whom post-operative plan is for
  ventilation due to type of surgery
• Children with very high risk of needing IPPV post
  operatively eg obstructive sleep apnoea, spastic
  quadriparesis

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Great Ormond Street Hospital NHS Trust

• Prospective audit of patients admitted to PICU
  within 48 hours of surgery
• Audit of booking indicators for patients booked
  into and not using PICU bed
• Cost savings calculated
• Support from float nurses trained in basic PICU
  charting and observation competencies
• Discharge planning on arrival

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Great Ormond Street Hospital NHS Trust
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Great Ormond Street Hospital NHS Trust
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Great Ormond Street Hospital NHS Trust
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Great Ormond Street Hospital NHS Trust
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Great Ormond Street Hospital NHS Trust

• Results
• Number of bookings reduced by 50
• Cancellations reduced by 65
• Number of patients using booked PICU beds
  increased from 38 to 55
• Probably cannot increase all ward returners had
  valid booking reasons
• No patients admitted as emergencies
  peri-operatively
• Cost savings 160,000 per annum
• Hospital grapevine has new top priority

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Great Ormond Street Hospital NHS Trust
Great Ormond Street Hospital NHS Trust

• Lessons Learned
• Involvement of key people
• Reporting into executive team
• Importance of descriptive data
• Sustainability cancellations built into
  performance indicators for PICU and ward
  returners for anaesthesia
• Has established a core cross disciplinary group
  for examining other issues (eg intensive care
  outreach)