HPB SO53 - Implementation of High Volume-Low Complexity 'GIRFT' lists for laparoscopic cholecystectomy

Abstract Background Waiting times for elective surgery have risen steadily since 2010, with particularly sharp increases after the Covid pandemic. There have been several initiatives to improve theatre productivity and increase operative numbers and these are broadly encompassed within GIRFT standards and the development of the concept of a High Volume-Low Complexity list. Current GIRFT standards recommend six laparoscopic cholecystectomies on an all-day operating list. This study aimed to describe the development and implementation of these lists within out district general hospital setting and outline the key barriers and solutions for other units to learn from. Method All patients on the waiting list for laparoscopic cholecystectomy were assessed and screened by a panel of consultant surgeons to assess suitability for a HVLC list. Theatre staff, anaesthetists and surgeons were widely consulted within local focus groups and a novel method of remuneration for additional work was developed: a 'cost-per-case (CPC)' remuneration structure was introduced (in contrast to standard remuneration by session time) to ensure productivity and high quality surgery. Operations were carried out on weekend lists in a dedicated accredited Elective Surgical Hub and staff were able to finish the day when all operations were completed. Results CPC lists took place from August 2023 to May 2024. All lists had six laparoscopic cholecystectomies or eight hernia repairs (or a combination) in line with GIRFT standards. Overall 124 cholecystectomies were performed and 119 were completed on a day case basis. The remaining 5 patients had a single night stay. There were no returns-to-theatre or major morbidity. All lists had started by 830AM and the latest finish time throughout the study period was 1525PM. The utilisation of CPC lists contributed to waiting times falling dramatically from over 52 weeks to 28 weeks by the end of the study period. Conclusion By utilising a novel form of remuneration, based on volume of work completed rather than time, we were able to maximise productivity without compromising safety whilst developing employment conditions that encouraged colleagues to perform additional work. Key facets to successful implementation include appropriate screening of cases, allowing staff to leave when the work is completed (rather than have to wait till the end of the day) and standardising equipment and kit to reduce wastage and turnaround time between cases. These lessons can be implemented in any surgical unit to improve productivity and increase volume of cases performed.