Orthopaedic Outpatient Triumph: Mastering Daycase Surgery
Preetham Kodumuri, Consultant Orthopaedic Surgeon, Betsi Cadwaladr University Health Board
Introduction
Our orthopaedic department faced a significant challenge with approximately 5000 patients waiting over 52 weeks for surgery, 60% of whom were suitable for minor daycase procedures. Theatre efficiency was hindered by staff absences, complex caseloads, and logistical issues, further straining resources.
A ‘Getting It Right First Time’ (GIRFT) meeting in North Wales highlighted the lack of dedicated theatre time as a major contributor to these issues. To address this, we aimed to reduce waiting lists and improve theatre efficiency by relocating minor daycase surgeries to a dedicated outpatient setting.
Methods
- Interviewed patients and families to ensure community value.
- Proposed a dedicated minor procedure room with the aim to shift minor daycase surgeries to free up main theatres and boost efficiency.
- Key stakeholders: orthopaedic surgeons, theatre staff, administrative personnel, facility management.
- Collaboration ensured clinical guidance, logistical insights, and workflow optimisation.
- Fostered ownership, accountability, and a culture of continuous improvement.
Several changes were implemented, and their impact assessed on efficiency and patient outcome:
- Identification of Suitable Location
- Leaner Surgical Instruments and Drapes
- Direct Outpatient Attendance
- Reduced Staff Requirements
- Procedure Volume
- Additional Theatre Time
Outcomes
- Enhanced Patient Experience: Streamlined care reduced hospital visit times from four hours to one hour.
- Improved Resource Utilisation: Reduced procedure costs with leaner instruments and drapes, and staff requirements per procedure decreased by 66%.
- Increased Surgical Throughput: Achieved a 20% improvement, allowing more surgeries within the same timeframe and reducing waiting times.
- Utilisation of Additional Theatre Time: Freed up theatre time equivalent to approx. 50 major surgeries.
- Positive Operational Impact: Improved overall theatre efficiency and workflow.
Learnings
- Swift adaptation to post-COVID challenges was crucial.
- Engaging diverse stakeholders fostered smooth implementation.
- Iterative process ensured sustained enhancements in service delivery.
- Prioritising patient needs guided decision-making.
What next?
- Share our experiences to a Quality Improvement in Practice journal
- Collaborate with the Bevan Commission in "Adopt and Spread" events.
- Evaluate initiatives, gather feedback and analyse KPIs
- Explore opportunities to expand and replicate initiatives in other departments.
