Theatre Improvement & Lean. Sharon Westmorland. Lean & Value Added. Lean is about identifying processes that Add Value and causing them to FLOW without interruption. KAIZEN. A Rapid Improvement Event. Admissions Team Improve 1st Patient in anaesthetic room time from 09:15 to 08:45
A Rapid Improvement Event
Admissions team: we did have the patient into the AR for 08.45 initially, but the institution of the surgical brief and pause has meant we have had to relax this target to 09.00 but we are actually achieving 08.55 on average
Staggered admissions: only a handful of surgeons have not adhered to this but this is work in progress
Change over team: we now have consistently low average T-A-T of 12 minutes.
Recovery team: we have reduced the delayed discharge from 30 mins to 5 mins (target was 11 mins)
Still have issues with the length of stay due to bed flow
Performance and planning: metrics, daily theatre utilisation board, weekly performance graphs, TOGs, monthly NTIG figures.
Environment team: storage, prep area, rationalisation of prostheses
Look at utilisation in other specialities
ENT – concerns around cancellations, turn-around times (surgeons opinion) and under-runs
Gyn – surgeons complained of our T-A-Ts
General surgery – concerns about over-runs, same day cancellations, under-runs
Share utilisation figures with service manager & surgeons
Discussed at divisional meeting Clinical Service Improvement Groups
Increase use of DSU in Monklands DSU
Patients contacted 2 days prior to confirm admission
Turn-around times - average between 11, 12 or 8 minutes
DNAs – 3%, 0%, 1.5%
Under-runs – 49, 15, 27 minutes under-run average. (23%, 12%, 17% of available time under-run)
Over-runs – 0%, 4% 11% over-runs of total available time.
The average turn around times for the Social Gynaecology list are only 5-8 minutes. This list usually has an extra member of staff to assist quick TA times.
The average TA time for the other elective lists in gynaecology was 23 minutes.
Revisited after staff education and Lean awareness training, the TA times are now 12 minutes; this has been sustained over the last year
Concerns about under-runs, over-runs and the number of short notice cancellations
Continue analysing and reporting all activity for all surgeons
Tie in with SPSP