Abstract
Introduction
Orthopaedic departments are increasingly put under pressure to improve services, cut waiting lists, increase efficiency and save money. It is in the interests of patients and NHS organisations to ensure that operating theatre resources are used to best effect to ensure they are cost effective, support the achievement of waiting time targets and contribute to a more positive patient experience.
Patients in the UK are expected to have undergone surgery once decided within 18 weeks. A good system of planning and scheduling in theatre enables more work, however is largely delegated to non-clinical managerial and administrative staff. After numerous cancellations of elective cases due to incomplete pre-operative work-up, unavailable equipment and patient DNAs, we decided to introduce a surgeon-led scheduling system.
Intervention
The surgeon-led scheduling diary involved surgeons offering patients a date for surgery in clinic. This allowed for appropriate organisation of theatre lists and surgical equipment, and pre-operative assessment.
Results
Prior to surgeon-led scheduling, there were a high number of patient DNAs (11%) and cancellations (15%), and 18-week target breaches (16%). Theatre utilisation was found to be 76%, with a booking efficiency of 80%. With surgeon-led scheduling, the number of cancellations reduced significantly (7%) although theatre utilisation remained similar (75%). Booking efficiency was reported to be 97%. There was a shorter waiting time by approximately 3 weeks and only 3% of patients breached their 18-week target.
Patients, theatre staff and surgeons were also surveyed. 100% of patients were satisfied with a date being offered in clinic, with 80% feeling less inclined to change or cancel the date of surgery. 100% of theatre staff were satisfied with the system, with improved communication and time to allocate surgical resources. 90% of surgical trainees reported improved satisfaction due to the mixed case-load and increased time for training.
Conclusion
In hospitals, optimising utilisation of operating theatres is essential both for patient care, efficiency and economy. We believe a surgeon led scheduling diary improves the patient experience in addition to surgical team satisfaction and morale
