Operating Theatre Efficiency Models of Care, Measures and Sustainability 
Jenny Abernethy 
Operations Director 
Surgery, A...
About Peninsula Health 
•Provides a full range of services across 14 major sites 
•Operating revenue of $450 million 
•820...
•Changing Culture Creating Certainty 
•Create certainty for the patient and staff 
•No patient cancellations on the day of...
Service 
Arrive on time Be available as rostered/scheduled Be here for the patients Open to the new challenges Open to cha...
Team Dynamics Workshop
Principles 
•Themed Operating Theatres 
•Move to 4 week schedule 
•Dedicated emergency Theatre 24hrs / 7 days 
•Separate E...
Balancing Elective & Emergency Surgery – Peninsula Health’s Journey 
Emergency 
Elective
Challenges faced 
• Theatre Capacity 
• Emergency Surgery 
• Staff availability 
• Funding 
• Elective Surgery Targets 
• ...
Waiting times!
This page is intended to help you think about how you feel at different stages in your journey through the Surgical Pathwa...
Happy 
Supported 
Safe 
Good 
Worried 
In Pain 
Lonely 
Sad 
Comfortable 
Patient Experience 
Emotional Experience 
Clarit...
Patient Story – Emergency Patient 
•Admitted on the 12/7 with Cholecystitis and discharged on the 21/7 
•Her emergency sur...
“Patients and families will bring ideas to the table that expand the horizons of health care professionals” 
Patient Centr...
Impact of the Emergency Model 
•Reduces twilight and after hours surgery 
•Decreases tension through increased resource al...
Balancing Elective & Emergency Surgery 
vs 
It is not just about chipping away but rather shaping and transforming the fut...
Why start operating sessions on time? 
•We should respect our patients 
•We should respect our fellow team members 
•Start...
Surgery Start Time Project 
•Patient arrival was defined as 6.45 am 
•Results showed 23% late 
•Patient tracking (arrival ...
Defines patient steps and staff responsibilities Working towards common goal Shared understanding of ‘start time’ Staff ro...
First Case Surgical Start Time 
Author: Lauren Manning, Peninsula Health, VIC 
Co-Authors: Karen Barker, LEAN This Way, VI...
ARRIVED PRE-OP 
07:30 07:30 07:30 08:00 07:30 
07:45 07:45 07:45 08:15 07:45 
08:00 08:00 08:00 08:30 08:00 
WITHIN 15 MIN...
TIME OUT – AM – SESSION START TIME 
WITHIN 10 MINUTES 
Green Starts 4 4 5 7 6 
Red/Amber 5 5 4 2 3 
% On Time 44.44% 44.44...
FINISH TIMES OF LAST CASES FOR THE DAY 
16:30 16:30 16:30 16:30 16:30 
16:45 16:45 16:45 16:45 16:45 
17:00 17:00 17:00 17...
Start Time Improvement - Frankston
Patient comments… 
“Love that the same nurse who calls the night 
before sees me the next morning for my admission” 
Senio...
Redesigning Stock & Inventory 
•Define the Problem 
•Create a functioning stock area for receiving and distributing of con...
Defining the Problems 
•Clutter in hall due to lack of delivery space 
•Risk of stock being lost or damaged 
•Excess stock...
•Barcoding system implemented 
•Reduced Inventory Holding 
•Documenting Freight Charges 
•Product Analysis 
•Consumable Ag...
Savings Opportunities 
•Product analysis 
–Usage and cost 
–Not relying on companies to provide analysis 
–Gowns savings d...
Measures of Efficiency and Theatre Optimisation 
•Start Times 
•Contact hours 
•Number of Procedures 
•Theatre Utilisation...
Frankston - Procedures & Contact hours
Contact Hours Mon - Fri
Contact Hours Mon - Fri
Contact Hours - Weekend
Contact Hours - Session
CONTACT HOURS PER WEEK 
Time Period Mon Tue Wed Thu Fri Sat Sun Grand Total 
07:00 - 12:00 32.33 36.82 32.52 32.02 27.75 9...
NUMBER OF PROCEDURES BY SESSION AND DAY OF WEEK 
Time Period Mon Tue Wed Thu Fri Sat Sun Grand Total 
07:00 - 12:00 27 30 ...
THEATRE UTILISATION 
Theatre Minutes Available Minutes Used % Used Number of Ops 
Emergency Theatre 10066 1814 52% 66 
FH ...
Anaesthesia
Unplanned Surgery
Cancellations for Emergency Patients
Cancellations on Day of Surgery
Length of Stay – Appendicectomy & Lap Chole 
YEAR 
2010 
2011 
2012 
2013 
2014 
G07A 
6.52 
4.98 
5.23 
3.71 
3.35 
G07B ...
Length of Stay – Hip Fractures 
0 
2 
4 
6 
8 
10 
12 
14 
16 
18 
2010 
2011 
2012 
2013 
2014 
Average of LOS 
I08A 
I08...
Elective Surgery Activity 2013 to 2014 
Elective Surgery Activity 2013 to 2014 
Total Elective Surgery Waitlist 2013 to 20...
Elective Surgery Long Waits 2013 to 2014 
0 
100 
200 
300 
400 
500 
600 
700 
800 
Jul-13 
Aug-13 
Sep-13 
Oct-13 
Nov-1...
Elective Surgery Long Waits 2013 to 2014 
Elective Surgery Cat 2 Long Waits 2013 to 2014 
Elective Surgery Cat 3 Long Wait...
General Surgery Long Waits 2013 to 2014 
Category 2 
Category 3 
0 
50 
100 
150 
200 
250 
300 
350 
400 
Jul-13 
Aug-13 ...
Sustainability 
•Daily operating suite meetings x 3 
•Weekly report to Surgical Executive to monitor performance 
•Early i...
•Create certainty for the patient and staff 
•Cancellations reduced 
•Patients prioritised 
•Safe and timely surgery and i...
Jenny Abernethy - Intensive Care Unit Frankston Peninsula Health - Operating Theatre Efficiency - Models of Care, Measures...
Jenny Abernethy - Intensive Care Unit Frankston Peninsula Health - Operating Theatre Efficiency - Models of Care, Measures...
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Jenny Abernethy - Intensive Care Unit Frankston Peninsula Health - Operating Theatre Efficiency - Models of Care, Measures and Sustainability

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Jenny Abernethy delivered the presentation at the 2014 Operating Theatre Management Conference.

Focusing on strategies for implementing the National Safety and Quality Health Service Standards and the importance of communication to improve patient safety and clinical practice, the 2014 Operating Theatre Management Conference brought together operating room management and perioperative professionals to review current initiatives across the country.

For more information about the event, please visit: http://bit.ly/optheatremgmt14

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Jenny Abernethy - Intensive Care Unit Frankston Peninsula Health - Operating Theatre Efficiency - Models of Care, Measures and Sustainability

  1. 1. Operating Theatre Efficiency Models of Care, Measures and Sustainability Jenny Abernethy Operations Director Surgery, Anaesthetic Services, Intensive Care Unit Peninsula Health
  2. 2. About Peninsula Health •Provides a full range of services across 14 major sites •Operating revenue of $450 million •820 beds and growing •9 operating theatres •Building a new ED and 3 new wards •Serves a population of 295,000 plus visitors • 4,900 staff, and over 800 volunteers
  3. 3. •Changing Culture Creating Certainty •Create certainty for the patient and staff •No patient cancellations on the day of surgery •Patients who require emergency surgery will be clinically prioritised and operated upon in a timely manner •Surgery and interventional procedures will occur in a safe and effective manner •Create the perfect list Aspirational Goals
  4. 4. Service Arrive on time Be available as rostered/scheduled Be here for the patients Open to the new challenges Open to change Work within Scope of Practice Seek teaching/learning opportunities Excellence Honest Openness Transparent Takes responsibility for own actions] Does not blame others Integrity Arrive on time Equality of all staff Consider the situation when making requests Put yourself in their position Interact with colleagues as you would like to be interacted with Acknowledgement of others actions Respect Be aware of colleagues situation Take holistic view of patient Communicate Be approachable Work together Staff enjoy their role & workplace Positive attendance Take responsibility Help others Compassion Professionalism Staff Behaviour Surgery & Anaesthesia – Team Working - Behaviour
  5. 5. Team Dynamics Workshop
  6. 6. Principles •Themed Operating Theatres •Move to 4 week schedule •Dedicated emergency Theatre 24hrs / 7 days •Separate Emergency Orthopaedic Surgery from the Emergency Theatre •Additional Elective Surgery Time for Orthopaedic & Vascular Surgery •Additional capacity for targeted initiatives in Plastics, Urology & ENT •Increase Rosebud Theatre Utilisation
  7. 7. Balancing Elective & Emergency Surgery – Peninsula Health’s Journey Emergency Elective
  8. 8. Challenges faced • Theatre Capacity • Emergency Surgery • Staff availability • Funding • Elective Surgery Targets • Emergency Dept. Targets • Equipment • Bed access
  9. 9. Waiting times!
  10. 10. This page is intended to help you think about how you feel at different stages in your journey through the Surgical Pathway. Put a circle around the words that best describes your feeling at each stage, or write your own words at the bottom. How did you feel ? If you’ve got time, we’d like to know why you felt like this. Was it friendly staff, a nice conversation, a long wait or an uncomfortable chair... whatever it is we’d like to know... Arriving/Checking In Waiting Going to Theatre Post Op. Phase Check Ups (Physio, OT, Nurse, Doctor) Leaving Information Happy Supported Safe Good Comfortable In pain Worried Lonely Sad Why ? Peninsula Health – Surgery Patient Survey Happy Supported Safe Good Comfortable In pain Worried Lonely Sad Happy Supported Safe Good Comfortable In pain Worried Lonely Sad Happy Supported Safe Good Comfortable In pain Worried Lonely Sad Happy Supported Safe Good Comfortable In pain Worried Lonely Sad Happy Supported Safe Good Comfortable In pain Worried Lonely Sad Happy Supported Safe Good Comfortable In pain Worried Lonely Sad
  11. 11. Happy Supported Safe Good Worried In Pain Lonely Sad Comfortable Patient Experience Emotional Experience Clarity about what happens to me Informed about procedures & risks Awareness of course of treatment “Certainty” Understanding aftercare/self- care Compliance assured Lifestyle changes Where to get help Worried Lonely In Pain Sad Supported Safe Good Comfortable Happy Patient Experience Emotional Experience Out of comfort zone Looking for answers “Uncertainty” Distressed/Waiting Clarity about what/when will happen Informed about procedures & risks Awareness of course of treatment “Certainty” Understanding aftercare/self-care Compliance assured Lifestyle changes Where to get help Elective Patient Emergency Patient
  12. 12. Patient Story – Emergency Patient •Admitted on the 12/7 with Cholecystitis and discharged on the 21/7 •Her emergency surgery was cancelled 6 times Her issues: •Casual worker who will lose up to 3 weeks work •Told she should be grateful as another lady upstairs was waiting one day longer •Staff were afraid to tell her she had been cancelled •When told she was cancelled, she just wanted a hug to release emotions •Angry at being pumped full of drugs for best part of 8 days •When going to surgery finally, paperwork not completed correctly and she was scared she would be cancelled •First happy face she saw was the surgeon who said he was going to operate on her
  13. 13. “Patients and families will bring ideas to the table that expand the horizons of health care professionals” Patient Centred Care Tom Delbanco, M.D., and Sigall K. Bell, M.D. N Engl J Med 2007; 357:1682-1683
  14. 14. Impact of the Emergency Model •Reduces twilight and after hours surgery •Decreases tension through increased resource allocation within hours •Creates certainty by focusing on standard operating procedures •Decreases on-the-day cancellations for elective surgery patients •Decreases cancellations of unplanned surgical cases •Creates certainty o for emergency surgery o for the elective patient o for staff
  15. 15. Balancing Elective & Emergency Surgery vs It is not just about chipping away but rather shaping and transforming the future
  16. 16. Why start operating sessions on time? •We should respect our patients •We should respect our fellow team members •Starting the day on time means we have a better chance of finishing the day on time •We may be able to do additional minor procedures in the session •Risk of patients being cancelled is reduced •Create certainty for patients and staff “I have noticed that the people who are late are often so much jollier than the people who have to wait for them.” E.V Lucas (1868-1938)
  17. 17. Surgery Start Time Project •Patient arrival was defined as 6.45 am •Results showed 23% late •Patient tracking (arrival to surgery start) •Admission process was time consuming on day of surgery (up to 30 min) •Nursing and medical staff wanting to access the patient on day of surgery – multiple interruptions, staff coming and going •Patients waiting in the Admission consulting rooms – unclear why they were delayed Patient perspective Patient comments: “lost in the dark” “poor signage and lighting - arrived in wrong area” “confused with instructions” “slept in!”
  18. 18. Defines patient steps and staff responsibilities Working towards common goal Shared understanding of ‘start time’ Staff rosters re-aligned to support agreement Surgical ‘Team Agreement’
  19. 19. First Case Surgical Start Time Author: Lauren Manning, Peninsula Health, VIC Co-Authors: Karen Barker, LEAN This Way, VIC and Ally O’Dell, Nurse Manager Surgical Services Problem: Delayed surgery start time impacted on the ability to finish on time. Goal: To have reliable first case surgery start time. Background: Multiple problems associated with delays to first case surgery start time • Extended wait times for patients to access surgery even despite being the first case • Frustrations for staff as the co-ordination of timely and safe care was problematic at the start of the day and some staff were waiting for the patient be processed in Admissions • Staff downtime, high staffing costs • Affected the ability to provide additional surgical cases VSM surgical services.igx Patient Clerical Total C/T = 1 minutes Value Add: 1 minutes NVA = 0 minutes 2 OR timeout Total C/T = 24 minutes Value Add: 24 minutes NVA = 0 minutes Central W/L 1 minutes 6 minutes 11.3 minutes 36.3 minutes 12 minutes 8 minutes 1 minutes 11 minutes 28 minutes 22 minutes 24 minutes Lead Time = 138 minutes VA / T = 56.3 minutes NVA = 72 minutes 0 minutes 6 minutes 15 minutes 12 minutes 0 minutes 0 minutes 17 minutes 22 minutes 0 minutes Consulting Rooms Total C/T = 36.3 minutes Value Add: 11.3 minutes NVA = 15 minutes 3 Pre Op Area Total C/T = 8 minutes Value Add: 8 minutes NVA = 0 minutes Total C/T = 12 minutes 2 Value Add: 0 minutes NVA = 12 minutes Total C/T = 6 minutes Value Add: 0 seconds NVA = 6 minutes Distance Traveled: 5 m Anaesthetic Total C/T = 28 minutes Value Add: 11 minutes NVA = 17 minutes Total C/T = 22 minutes Value Add: 0 minutes NVA = 22 minutes Pre Admission Total C/T = 4 hours Uptime = 35% admissions desk - IPM Total C/T = 1 minutes Value Add: 1 minutes NVA = 0 minutes Pink Hat Coordinator improve add on notification Standardise pt processing by nursing Improve patient arrival times Defect = 65% Visual Mgt & Signalling b/w disciplines Introduce pull systems into Pre Op Shared understandng of time out and subsequent processing times by all staff Introduce Early Warining System to escalate first case delays Day prior processing ? telephone assessments and EWS for issues Review staffing and balance to meet timeout aims Key performance measures avaliable visually on a daily basis for all staff Value Stream Mapping - First Case Surgical Start Time Patient's information packs - opportunities to improve Aims with Interventions: Improve patient arrival time delays by: • Consistent and streamlined information • Improved signage for day of arrival • Introduction of day prior phone call and admission checklist Reducing patient processing time on day: • Dedicated patient processing time with a Time Out agreement • Revised scheduling and staggered admission times • Standard consulting rooms layout Achievements:  We have achieved average start time delay from 16 min to 9 min (37% reduction in delays to first case surgery start time)  Patient arrival times have improved by at least 11%  Patients happier with clear written and verbal instructions  Reduced processing times through the admissions area  Staff aligned in their definition of surgery start time  Staff morale has significantly improved Stakeholder Engagement:  Regular staff workshops  Staff surveys across all disciplines  Process mapping and Value Stream mapping  Clerical staff audits - patient arrival times  Regular meetings with management Visual patient tracking board in Admissions to • Identify patients steps from arrival to pre-op hold • Reduce interruptions • Improve flow of patient by moving in one direction Key Learning's: Define the problem, engage all staff, strong leadership , executive support and continuously improve
  20. 20. ARRIVED PRE-OP 07:30 07:30 07:30 08:00 07:30 07:45 07:45 07:45 08:15 07:45 08:00 08:00 08:00 08:30 08:00 WITHIN 15 MINUTES Green Starts 6 5 7 8 7 Red/Amber 3 4 2 1 2 % On Time 66.67% 55.56% 77.78% 88.89% 77.78% Mon Tue Wed Thu Fri F Theatre 1 07:38 07:35 07:45 07:54 07:32 F Theatre 2 07:44 07:30 07:37 07:36 07:27 F Theatre 3 07:25 07:47 07:23 07:27 07:50 F Theatre 4 07:35 07:21 07:27 07:59 07:34 F Theatre 5 07:28 07:26 07:33 07:45 07:25 F Theatre 6 07:41 07:45 07:32 07:55 07:25 F Theatre 7 07:55 08:19 07:42 08:27 08:02 F Theatre 8 07:47 07:50 07:29 08:10 07:20 R Theatre 1 08:10 07:50 07:58 08:22 07:45
  21. 21. TIME OUT – AM – SESSION START TIME WITHIN 10 MINUTES Green Starts 4 4 5 7 6 Red/Amber 5 5 4 2 3 % On Time 44.44% 44.44% 55.56% 77.78% 66.67% 08:15 08:15 08:15 08:50 08:15 08:25 08:25 08:25 09:00 08:25 08:35 08:35 08:35 09:10 08:35 Mon Tue Wed Thu Fri F Theatre 1 08:28 08:30 09:00 08:53 08:08 F Theatre 2 09:12 08:21 08:32 09:05 08:26 F Theatre 3 08:15 08:35 08:20 08:45 08:21 F Theatre 4 08:24 08:25 08:18 09:04 08:20 F Theatre 5 08:36 08:26 09:10 08:50 08:27 F Theatre 6 08:30 08:27 08:25 08:40 08:34 F Theatre 7 08:39 09:00 08:15 09:20 08:40 F Theatre 8 08:18 08:15 08:10 08:30 08:16 R Theatre 1 08:18 08:23 08:07 08:27 08:18
  22. 22. FINISH TIMES OF LAST CASES FOR THE DAY 16:30 16:30 16:30 16:30 16:30 16:45 16:45 16:45 16:45 16:45 17:00 17:00 17:00 17:00 17:00 WITHIN 15 MINUTES Green Finish 2 2 5 2 3 Red/Amber 6 6 3 6 5 % On Time 25.00% 25.00% 62.50% 25.00% 37.50% Mon Tue Wed Thu Fri F Theatre 1 16:45 15:00 16:40 15:30 16:20 F Theatre 2 16:25 15:59 16:35 17:15 16:32 F Theatre 3 15:50 17:05 16:45 15:43 19:45 F Theatre 4 16:50 16:00 15:20 16:42 16:10 F Theatre 5 17:03 16:30 16:10 16:30 15:50 F Theatre 6 16:52 18:00 16:30 16:50 14:30 F Theatre 7 22:24 22:45 21:50 15:45 22:41 F Theatre 8 09:35 16:45 12:00 15:32 16:00 R Theatre 1 11:05 14:30 16:27 14:40 16:25
  23. 23. Start Time Improvement - Frankston
  24. 24. Patient comments… “Love that the same nurse who calls the night before sees me the next morning for my admission” Senior Anaesthetist’s comments… "This project has resulted in one of the most successful change management processes in Surgery and Anaesthesia Services at Peninsula Health...“ Surgeon’s comments … “ its great, patients are arriving on time and are ready - there is now a reason for us to be on time” Surgery Start Time Project - Feedback
  25. 25. Redesigning Stock & Inventory •Define the Problem •Create a functioning stock area for receiving and distributing of consumables •Ordering system to gain inventory control and improve efficiency •Provide support to Theatre Staff and improve Theatre function •Decrease costs •Provide accurate financial reporting Changing Culture Creating Certainty
  26. 26. Defining the Problems •Clutter in hall due to lack of delivery space •Risk of stock being lost or damaged •Excess stock on shelves •Staff coming out between procedures for stock •Patients and visitors having access to this non secure area
  27. 27. •Barcoding system implemented •Reduced Inventory Holding •Documenting Freight Charges •Product Analysis •Consumable Agreements Receiving and Distributing of Consumables
  28. 28. Savings Opportunities •Product analysis –Usage and cost –Not relying on companies to provide analysis –Gowns savings disposable vs. linen –Review pricing agreements •Freight costs –Ensure correct cost centre charged –Identifies suppliers who charge incorrect costs –Product costs vs. freight costs analysis •Theatre recycling –Identified opportunities –Recycling PVC and segregating waste items
  29. 29. Measures of Efficiency and Theatre Optimisation •Start Times •Contact hours •Number of Procedures •Theatre Utilisation •Anaesthesia RVG’s •Pre-operative time to surgery •Elective Cancellations for emergencies •Elective cancellations on day of surgery •Length of stay •Elective Surgery Waiting List impact
  30. 30. Frankston - Procedures & Contact hours
  31. 31. Contact Hours Mon - Fri
  32. 32. Contact Hours Mon - Fri
  33. 33. Contact Hours - Weekend
  34. 34. Contact Hours - Session
  35. 35. CONTACT HOURS PER WEEK Time Period Mon Tue Wed Thu Fri Sat Sun Grand Total 07:00 - 12:00 32.33 36.82 32.52 32.02 27.75 9.87 9.82 181.12 12:00 - 17:00 21.43 25.65 20.77 21.97 52.18 6.83 7.23 156.07 17:00 - 22:00 3.00 3.42 3.38 0.00 5.97 4.57 6.58 26.92 22:00 - 07:00 2.00 0.75 1.25 0.00 1.08 2.80 1.43 9.32 Grand Total 58.77 66.63 57.92 53.98 86.98 24.07 25.07 373.42 0 50 100 150 200 250 300 350 400 450 w/e 6th w/e 13th w/e 20th w/e 27th w/e 3rd w/e 10th w/e 17th w/e 24th w/e 31st w/e 7th w/e 14th w/e 21st w/e 28th w/e 5th w/e 12th w/e 19th w/e 26th w/e 2nd w/e 9th w/e 16th w/e 23rd w/e 30th w/e 7th w/e 14th w/e 21st w/e 28th w/e 4th w/e11th w/e 18th w/e 25th w/e 1st w/e 8th w/e 15th w/e 22nd w/e 1st w/e 8th w/e 15th w/e 22nd w/e 29th w/e 5th w/e 12th w/e 19th w/e 26th w/e 3rd w/e 10th w/e 17th w/e 24th w/e 31st w/e 7th w/e 14th w/e 21st w/e 28th Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Hours Total Contact Hours Per Week Previous Year 2014 - 2015
  36. 36. NUMBER OF PROCEDURES BY SESSION AND DAY OF WEEK Time Period Mon Tue Wed Thu Fri Sat Sun Grand Total 07:00 - 12:00 27 30 28 28 34 5 5 157 12:00 - 17:00 16 20 21 27 26 3 6 119 17:00 - 22:00 3 2 4 0 3 2 3 17 22:00 - 07:00 1 4 1 0 1 2 1 10 Grand Total 47 56 54 55 64 12 15 303 0 50 100 150 200 250 300 350 400 w/e 6th w/e 13th w/e 20th w/e 27th w/e 3rd w/e 10th w/e 17th w/e 24th w/e 31st w/e 7th w/e 14th w/e 21st w/e 28th w/e 5th w/e 12th w/e 19th w/e 26th w/e 2nd w/e 9th w/e 16th w/e 23rd w/e 30th w/e 7th w/e 14th w/e 21st w/e 28th w/e 4th w/e11th w/e 18th w/e 25th w/e 1st w/e 8th w/e 15th w/e 22nd w/e 1st w/e 8th w/e 15th w/e 22nd w/e 29th w/e 5th w/e 12th w/e 19th w/e 26th w/e 3rd w/e 10th w/e 17th w/e 24th w/e 31st w/e 7th w/e 14th w/e 21st w/e 28th Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Procedures Total Procedures Per Week Previous Year 2014 - 2015
  37. 37. THEATRE UTILISATION Theatre Minutes Available Minutes Used % Used Number of Ops Emergency Theatre 10066 1814 52% 66 FH Theatre (Excluding Emerg) 16796 11060 93% 207 Rosebud Theatre 2250 2160 61% 33 0% 20% 40% 60% 80% 100% 120% w/e 6th w/e 13th w/e 20th w/e 27th w/e 3rd w/e 10th w/e 17th w/e 24th w/e 31st w/e 7th w/e 14th w/e 21st w/e 28th w/e 5th w/e 12th w/e 19th w/e 26th w/e 2nd w/e 9th w/e 16th w/e 23rd w/e 30th w/e 7th w/e 14th w/e 21st w/e 28th w/e 4th w/e11th w/e 18th w/e 25th w/e 1st w/e 8th w/e 15th w/e 22nd w/e 1st w/e 8th w/e 15th w/e 22nd w/e 29th w/e 5th w/e 12th w/e 19th w/e 26th w/e 3rd w/e 10th w/e 17th w/e 24th w/e 31st w/e 7th w/e 14th w/e 21st w/e 28th Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Percentage % Used of Available Emergency Theatre FH Total (Excluding Emerg) Rosebud Theatre
  38. 38. Anaesthesia
  39. 39. Unplanned Surgery
  40. 40. Cancellations for Emergency Patients
  41. 41. Cancellations on Day of Surgery
  42. 42. Length of Stay – Appendicectomy & Lap Chole YEAR 2010 2011 2012 2013 2014 G07A 6.52 4.98 5.23 3.71 3.35 G07B 2.55 2.48 2.27 2.03 1.92 H08A 7.92 6.9 5.62 4.21 3.61 H08B 1.83 2.12 1.72 1.69 1.5 0 1 2 3 4 5 6 7 8 9 2010 2011 2012 2013 2014 Average of LOS G07A G07B H08A H08B G07A = Appendicectomy with Complication G07B = Appendicectomy without H08A = Laparoscopic Cholecystectomy with Complication H08B = Laparascopic Cholecystectomy without
  43. 43. Length of Stay – Hip Fractures 0 2 4 6 8 10 12 14 16 18 2010 2011 2012 2013 2014 Average of LOS I08A I08B I08A = Other Hip and Femur Procedures W Catastrophic CC I08B = Other Hip and Femur Procedures W/O Catastrophic CC YEAR 2010 2011 2012 2013 2014 I08A 17.01 14.53 13.73 10.93 8.45 I08B 8.98 6.65 7.63 6.42 5.14
  44. 44. Elective Surgery Activity 2013 to 2014 Elective Surgery Activity 2013 to 2014 Total Elective Surgery Waitlist 2013 to 2014 0 100 200 300 400 500 600 700 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 No. of Patients Actual Activity Target 2013-14 Previous Year 2013-14 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Actual Activity 555 549 549 635 490 462 534 560 536 540 604 585 Target 2013-14 552 530 528 616 550 460 532 558 590 532 540 590 Previous Year 600 584 484 594 589 387 371 482 490 506 500 506 0 500 1000 1500 2000 2500 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 No. of Patients Actual Waitlist Target 2013-14 Previous Year 2013-14 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Actual Waitlist 1801 1872 1800 1718 1678 1588 1637 1616 1594 1543 1445 1379 Target 2013-14 1816 1875 1850 1830 1810 1790 1700 1650 1600 1550 1500 1435 Previous Year 1664 1724 1737 1742 1740 1778 1896 1914 1862 1861 1901 1765
  45. 45. Elective Surgery Long Waits 2013 to 2014 0 100 200 300 400 500 600 700 800 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 No. of Patients Actual Long Waits Target 2013-14 Previous Year 2013-14 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Actual Long Waits 607 611 531 535 481 500 515 469 457 456 435 385 Target 2013-14 610 630 610 590 565 540 520 495 470 440 410 380 Previous Year 467 475 495 489 514 598 675 683 639 607 639 585
  46. 46. Elective Surgery Long Waits 2013 to 2014 Elective Surgery Cat 2 Long Waits 2013 to 2014 Elective Surgery Cat 3 Long Waits 2013 to 2014 0 100 200 300 400 500 600 700 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 No. of Patients Actual Long Waits Target 2013-14 Previous Year 0 20 40 60 80 100 120 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 No. of Patients Actual Long Waits Target 2013-14 Previous Year 2013-14 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Actual Long Waits 91 101 72 75 61 55 52 44 42 40 36 32 Target 2013-14 91 100 95 90 85 82 80 75 70 65 60 55 Previous Year 43 46 46 56 71 72 85 88 90 84 82 85 2013-14 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Actual Long Waits 516 510 460 460 420 445 463 425 415 416 399 353 Target 2013-14 519 530 515 500 480 458 440 420 400 375 350 325 Previous Year 424 429 449 433 443 526 590 595 549 523 557 500
  47. 47. General Surgery Long Waits 2013 to 2014 Category 2 Category 3 0 50 100 150 200 250 300 350 400 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 No. of Patients General Cat 2 - '13 to '14 All Patients Long Waitetrs 2013 to 2014 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 All Patients 353 318 284 256 247 218 210 215 214 176 152 178 Long Waitetrs 142 129 116 90 67 70 71 61 49 37 30 28 0 5 10 15 20 25 30 35 40 45 50 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 No. of Patients General Cat 3 - '13 to '14 All Patients Long Waitetrs 2013 to 2014 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 All Patients 40 44 37 30 23 22 26 20 23 19 18 17 Long Waitetrs 7 9 3 4 2 1 2 1 1 0 1 0
  48. 48. Sustainability •Daily operating suite meetings x 3 •Weekly report to Surgical Executive to monitor performance •Early identification and escalation of issues •Review outliers •Weekly review of theatre lists •Monitor Elective KPI’s •Celebrate the successes
  49. 49. •Create certainty for the patient and staff •Cancellations reduced •Patients prioritised •Safe and timely surgery and interventional procedures •Length of stay improved •Activity optimised •The perfect list! Summary “Care is constantly reviewed and opportunities for improvement identified”

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