On the day non-clinical cancelled operations (elective)

1. 1 Signed off by: Hospital Non-Clinical Cancelled Operations as % of Elective Operations Signed off by: • Jenny Leggott - Revised date to meet standard Jenny Leggott Revised date to meet standard % of last minute elective cancellations for non-clinical reasons. Last minute means on the day the patient was due to arrive, or after the patient has arrived in hospital, or on the day of operation On the day non-clinical cancelled operations (elective) Prior to the day non-clinical cancelled operations (elective) Validated reason breakdown is only available from May 2012 Total non-clinical cancelled operations (elective) Cancelled prior to day On the day non-clinical cancelled operations (elective) Indicator level 1 Latest performance Latest performance • Standard • Standard YTD YTD Forecast Forecast Expected date to meet standard: Expected date to meet standard: Total non-clinical cancelled operations (elective) Indicator level TBC 2.56% 0.87% • 0.80% • TBA 0.79% Green - TBC 2.32% - 1

2. 1 Hospital Non-Clinical Cancelled Operations as % of Elective Operations Agreed corrective actions (planned and commenced) Issues causing underperformance % of last minute elective cancellations for non-clinical reasons. Last minute means on the day the patient was due to arrive, or after the patient has arrived in hospital, or on the day of operation A total of 185 operations were cancelled of which 63 were cancelled on the day of admission – this equates in total to 2.55 % of elective admissions. In the same period 7,233 elective procedures were undertaken at NUH. The main reason for on the day cancellations in June was clinical priority. This includes patients cancelled to accommodate emergency cases and list overruns due to other patients developing complications and taking more theatre time than planned. There was also a higher than usual number of cancellations due to ward and critical care bed availability which is associated with pressure on emergency surgical capacity in June. This has not been replicated in July to date. Three patients were cancelled for the second time on the day in June due to a combination of previous patient complications in theatre, insufficient critical care capacity and a supply issue of a specific drug required for an operation. Two of the patients have had treatment and a further patient is dated in July. The 15 patients cancelled more than once, including prior to the day, were mostly rescheduled to accommodate more clinically urgent or cancer patients. Work continues to be done to reduce the level of both on and prior to the day cancellations at NUH and to sustain the reduction we achieved in 12/13. However, further work is required to reduce to a level below target and this will focus at individual specialty and operating list level. A Project Manager has been appointed to lead this further work and came into post in July. The Project Manager is working closely with Theatre teams to set up an RCA (root cause analysis) process to understand better to underlying causes of cancellation on the day. An early focus will be to identify ways in which specialties can work differently to reduce the likelihood of patients being rescheduled prior to the day. In the meantime, work continues to roll-out an improved theatre scheduling process alongside the right sized theatre timetable. Better for You improvement work in Sterile Services is ongoing. The drug supply issue which caused the second on the day cancellation has been addressed and additional processes have been put in place in both Pharmacy and Neurosurgery to ensure that the issue cannot reoccur.