Admission on the Day of Surgery

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Admission on the Day of Surgery
Daniel de Rozarieux General Manager for
Critical care On behalf of Mark
Kemp Assistant Director of Operations
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Admission on the Day of Surgery

• Overview
• Background
• Surgical LoS
• Cancellation rate
• Efficiency programme
• Patient experience
• Implementation
• Agreeing patient pathway
• Logistical changes
• Launch
• Benefit realisation
• Reduced length of stay
• Reduction in surgical bed compliment
• Patient experience

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• Background reason for change
• Surgical Average LoS 6.5 days
• Improved access required to meet elective Dec
  2005 targets
• High Cancellation rate No Beds
• Efficiency programme improving theatre
  utilisation and reducing running costs in
  surgical wards
• Patient experience poor mostly admitted late
  afternoon therefore clerked / consented on the
  day of operation

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• Implementation
• Working group established to
• Identify the ideal patient pathway pilot
  initially for general surgery
• Establish a one stop pre assessment service
  incorporating nurse orientation, clerking and
  consent
• Logistical challenges
• Changing pre-op time table
• Introducing electronic surgical specific consent
  forms / clerking sheets / TTO forms
• Patient information / admission letters
• Launch at local meetings required full buy in
  from juniors to make sure everyone is at the
  right place at the right time

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• Benefit realisation
• Edgecombe 1 ward previously 27 beds
• Demand and capacity exercise undertaken to
  identify actual number of beds needed 18
• Theatre timetable changes to weight inpatient
  surgery at the beginning of the week close E1
  every weekend from 5pm on Friday
• As programme rolled out bed requirement flexes on
  a daily basis between 18 25
• Improved patient experience
• Reduction in LoS

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Introduction of admission of day of surgery
Add activity to meet Dec 2005 target
Continual drop rolled out to Urology and Gynae
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• Next Steps
• Total reconfiguration of surgical bed stock
• Elective surgery to be centralised to E1 and E2
• Non elective surgery to be centralised to F1, B1
  and B2
• Reduction in bed compliment of 12 (and E1 still
  shut at weekends)
• Advantages
• One ring fenced capacity for elective surgery
  simplifying bed management
• Dependent on ring fenced bed compliment
  minimises risk of cancellations ensure income
  and waiting time targets met
• Reduction in nursing vacancies plus assist in
  cross training
• Centralisation of pre-assessment services
• Provide an Early Health Screening service for all
  additions to the waiting list
• Education opportunity OT / Physio
• Admission lounge for all patients
• Walk to theatres

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• Questions
• Contact details
• Mark.kemp_at_mayday.nhs.uk