186 Improving Emergency General Surgery Theatre Efficiency Through a Structured Warm List Pathway: A Closed Loop Audit at a Tertiary Hospital in London

Abstract Aim To improve Emergency General Surgery (EGS) theatre efficiency through the implementation of a structured Warm List pathway, aligned with GIRFT principles. Method A closed loop audit was conducted over two cycles. The first cycle reviewed EGS lists from January to June 2023. The second cycle, from October 2024 to March 2025, followed the implementation of a Warm List pathway. Data were collected on list usage, procedures performed, cancellations, and discharge outcomes. Results In the first cycle, 57 out of 71 scheduled lists were completed. A total of 102 procedures were performed (average 1.8 per list), with eight lists cancelled due to no suitable emergency cases. Same day discharge was achieved in 37 percent of cases. The Warm List pathway introduced defined inclusion criteria: patients ASA I or II, low anaesthetic risk, suitable for hernia repair or lymph node biopsy, able to attend on short notice, commute within one hour, aware of possible cancellation, and accompanied by an escort. Patients were reviewed, consented, and added to the Warm List for rapid scheduling. Following implementation, 12 additional patients were safely operated on using previously unused time. Conclusions The Warm List pathway improved EGS theatre utilisation and patient flow, reducing cancellations and enhancing efficiency. This approach supports better use of emergency theatre resources and improved patient experience.