Neurosurgery : Adventures in Seamless Surgery

1. Neurosurgery : Adventures in Seamless Surgery Deborah Brodie Service Manager, Neurosciences Dr Karl Brennan Consultant in Neuroanaesthesia & Neurocritical Care and Clinical Lead for Seamless Surgery Sheffield Teaching Hospitals NHS FT

3. Key Metrics April – February 2016/17 & 2017/18 Source: Seamless Surgery Dashboard

4. How have things improved? • LiA (Listening into Action) project • Weekly planning meeting • Consultant Meeting • Communicating information across the team and understanding of roles

5. THEATRE WALKABOUT 1. LiA PERFECT LISTS

6. 9 Hour day - data

10. Rubbish!?

11. Wasters!?

12. Early start!!

13. NO GAPS!! 99.5% Touch Time!!

14. IMPROVEMENT

15. 2. Weekly planning meeting Attendance: • Consultant Neurosurgeon (Theatre Lead but others attend) • Lead Practitioner • Service Manager • Service Co-ordinator • Consultant Neuroanaesthetist • Service Improvement • Circulated minutes with action points • Discussion with team regarding list composition • Review of previous week and analysis of changes after planning meeting

16. Example of problem solving within planning meeting List Finish Times • Neurosurgery lists 8:30 – 18:30 • Generally lose around 10% of theatre time to early finishes • Which lists finish early? • ID lists which could finish at 17:30 • Permanent change to 17:30 after 3 month trial period • Now reviewing 2nd list

17. Example of problem solving within planning meeting Theatre 5B • Preparation of patients • Closer scrutiny of late starts • Preparation of theatre • 7.30 am start • Equipment • Neuro trolley • 7.30 am start

18. 3. Consultant Meeting • Involving consultant team in detail of theatre planning • Review list utilisation • Review Seamless Surgery Dashboard data • OPD v IP queues (and other issues) • Fill lists and other cover arrangements within the meeting • Review & plan holiday weeks in advance

19. 3. Consultant Meeting

20. 4. Communicating information across the team and understanding of roles • Consultant Meeting • Weekly email updates (Consultants and Secretarial team) • How did we do last week? Good/Not so Good • On the day cancellations • Start times • Theatre utilisation • Problems and how they were solved • Progress against targets • Comparison with Trust as a whole • Bi-monthly newsletter (Unsung Heroes of Neurosurgery) • Keep it varied and interesting (?)

21. Unforeseen Consequences • Decrease in IPWL • Consultants more likely to pool patients • Emphasis on theatres to detriment of OPD • Complacency – need a fresh approach

23. Cancelled Lists • Profiling • No lists cancelled within 2 weeks • Cancellation reasons • Profiled ↓ 59 lists (50 more to cancel at positive booking stage)

25. In Summary • Improved efficiency • Fewer late finishes (↓31%) • 34% fewer on the day cancellations • Increased case per list (+5.4%) • Lists cancelled at least 2 weeks in advance

26. In Summary • Reduced staff absenteeism in theatres • Well attended, functioning planning meeting • Engagement of staff/Good committed team • We need to keep going! Keep the message in as many minds as possible as often as possible.

27. Any Questions?