Transforming Orthopaedic Theatres!

1. Transforming Orthopaedic Theatres! Alison Todd Lean Project Manager

2. Context • NHS Borders – 110,000 population • 5 theatres • 1 orthopaedic theatre • 5 orthopaedic surgeons • Activity – 340 joints per year

3. Problems • 20% Shortfall in orthopaedic capacity • £550,000 cost of send-aways • Average knife-to skin time: 09.50 • Inefficiencies in our processes reducing available operating time • Poor compliance with Patient Safety Programme recommendations

4. Aim • maximise orthopaedic theatre efficiency • minimise lost operating time at start of theatre lists (knife to skin 9am) • reduce unnecessary surgical bed days • address issues related to Patient Safety Programme implementation • increase team working

5. Lean • Process – eliminates waste adds value to the patient Improves performance patient is key • Tool kit • A way of working • Empowers staff

6. Staff buy in • Communication/ Lean awareness sessions • Project Team • Senior management support throughout the project

7. The Project Framework Project Timeline VSM Kaizen (incl. logistics) Preparation work (Including Training) Sustainability

8. What we found… • Inaccurate data on operation lists • 30-50% of operating lists changes on day of surgery • 45% were changes to the order of the lists • Poor communication between the ward and theatres incurring delays • Variation in downtime between procedures • Equipment / radiology conflict • Frequent overrunning of lists

9. Key changes and actions List reconstruction 4 weeks before:- Patient listed and pre-assessment booked 2 weeks before:- Pre-assessment 48 hrs before:- List locked down on sapphire management system

10. New Theatre List Change Mgt System

11. Key changes Improved start times • Adapted staff rotas to reflect changes Turnaround time (End surgery to knife to skin ) • Enhanced communication with orthopaedic ward • Improved patient transfer from ward to theatre • Reduced number of handovers from 6 → 3 Patient safety • No entry sign!

12. What we achieved

13. Multidisciplinary team effort The whole process works amazingly well. It was a pleasure to do the list and all seemed extremely well organised. Anaesthetist “Often I can wait 10 minutes between patients, today I did not wait at all” Peri-operative staff Bring me my 4th joint, an absolute bloody pleasure to be part of this!” Orthopaedic Surgeon

14. Still to do… • Same day admission for all arthroplasty demonstrated but not sustained (400 bed days/year) • Anaesthetic input pre-assessment process • Downstream flow (discharges) • Staff development - Physician Assistant Anaesthesia - Advanced scrub practitioners • Increase productivity to 4 joints per list

15. Lean Delivers? 4 theatres leaned including emergency theatre Main conclusions • Lean works! • Hard work and tears! BUT huge staff engagement and enthusiasm • Impressive changes – but consistency is major win

16. Questions?