The Establishment of High Intensity Turnover and Subsequently High Volume Low Complexity Theatre Lists in Nevill Hall Day Surgery Unit
Aneurin Bevan University Health Board
Introduction:
Post-pandemic elective surgical backlogs posed a major challenge for NHS Wales. Nevill Hall Day Surgery Unit (DSU) sought to reduce waiting times and increase theatre efficiency through High Intensity Turnover (HIT) and High Volume Low Complexity (HVLC) lists. These aimed to consolidate procedures and maximise throughput—without increasing costs or compromising care.
Methods:
Using Kotter’s 8-step model, a multidisciplinary team launched a pilot HIT list where one surgeon operated across two theatres with dual teams. Pre-operative assessment was digitised to streamline patient flow. Stakeholders from theatres, anaesthetics, surgery, admin, and leadership co-designed the approach. Successive Plan-Do-Study-Act (PDSA) cycles tested and refined the model, beginning with hernia repairs and later expanding to other procedures.
Outcomes:
- First HIT list: 13 hernias completed by 15:10 with excellent outcomes
- Second cycle: 16 hernia operations with reduced staff and lunch break
- Third cycle: 7 hernias completed on a standard list by 16:10
- HVLC extended to cholecystectomies (6 completed in one list)
- Digital pre-op process adopted Board-wide, improving patient and staff experience
- Turnaround times improved significantly; all GIRFT targets met or exceeded
- Patient feedback overwhelmingly positive; safety and satisfaction maintained
- HVLC/HIT now routine in DSU and expanded to Ysbyty Ystrad Fawr (YYF)
Learnings:
Success depended on multidisciplinary collaboration, early surgeon buy-in, shared ownership, and ongoing data analysis. Staff morale improved through participation in a high-impact, visible change. A key takeaway was the importance of embedding change via shared leadership and operational support.
What Next?
The model will expand to orthopaedics and gynaecology, with efforts to spread best practice across Health Boards and scale nationally. Ongoing evaluation and cross-site collaboration will sustain and grow this innovation, aligned with NHS recovery and efficiency priorities.
