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Orthopaedic Outpatient Triumph: Mastering Daycase Surgery

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:

  1. Identification of Suitable Location
  2. Leaner Surgical Instruments and Drapes
  3. Direct Outpatient Attendance
  4. Reduced Staff Requirements
  5. Procedure Volume
  6. 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.