iPREP - improving peri-operative efficiency and patient throughput

Abstract Our work shows the impact of inertia on NHS elective surgery sessions, with recommendations to reduce late starts, delays between patients, and unplanned, unfunded overruns. 40% of hospital budgets go on surgery. In Q3/2024 22,681 operations were cancelled for non-clinical reasons. A 2019 NHS Improvement report suggested that 300,000 more surgeries per annum could be achieved through improved scheduling alone. Through quantitative informatics, qualitative data comprising structured observation of the whole patient journey to capture inertia and stakeholder interviews with service users we examined this in a large regional centre. In main theatres 1,912 sessions were reviewed with 1,915 hours of session time identified as unused due to late starts (25%). In ambulatory theatres 911 sessions were reviewed with 517 hours of session time unused due to late starts (12.5%). 51% of overruns were avoidable had prompt session starts been achieved. The structured observation (n = 5) highlighted a number of recurring issues. Incomplete patient preparation 100%, large footprint of hospital 100%, administrative omissions 80%, communication 80%, completion of care plan 80%, availability of lifts 80% and availability of staff 60%. Stakeholder interviews (n = 18) identified common factors affecting efficient session utilisation. Communication 100%, delayed patient turnaround 89%, late session starts 78%, delayed patient admission 78%, lack of theatre team influence over ward delays 78% and unplanned, unfunded overruns 67%. Two evidenced based, but underused, interventions are the use of Surgical Link Practitioners to ensure good patient preparation and that surgical pre-checks are completed, and using Theatre Turnaround Teams to expedite patient throughput. The WHO Surgical Safety Checklist has been shown to reduce surgical complications and mortality. We now propose a pre-surgical checklist to improve both clinical preparation and session utilisation. Key messages • Efficient surgical session utilization. • System-led healthcare.