Trust Board Febuary 2010 - Sandwell & West Birmingham Hospitals

SWBFC (1/10) 010
also playing some part in the overall trend.
Mr Trotman asked whether there was a key member of staff who had the
responsibility for reviewing the entire theatre pathway from organisation on the
ward to delivery of the patient to theatre and preparation for surgery. He was
advised that each theatre has an assigned team leader that takes this perspective.
In addition, there are a number of individuals with responsibility for the overall coordination
and performance monitoring of a set of theatres, to which issues
requiring escalation may be addressed.
Mrs Hunjan remarked that it was encouraging to hear that the plans for improving
performance were being discussed, but questioned whether the definition of a late
start and an early finish had been clearly promulgated and were understood. She
was advised that there was now a consistent view as to what constituted a late
start or early finish. Mrs Davis asked whether, in addition to this internal
understanding, there was any external information that could guide these
definitions. Mrs Bromley advised that there is currently no available benchmarking
information, although work is underway to develop this material. Mr Kirby added
that he was planning to ask if his counterparts across the region would be willing to
share their performance to assist with this matter.
Mr Kirby reported that although performance with late starts was improving well,
that there was further work to do in respect of early finishes. In addition to tracking
the number of theatre lists that were finishing early, the aggregated time lost as a
consequence is also being recorded. This information suggests that there is now less
overall time lost, although it is acknowledged that there is further work to do to
deliver an improved performance. Mr Trotman asked whether the effect of
emergency cases on theatre lists was being taken into account as part of this work.
He was advised that this was not the case.
Mr Kirby advised that the number of overall theatre sessions being used is steadily
rising, although the throughput of patients per list is steady. Until the late starts
performance had improved, there had been little opportunity to look at increasing
the number of patients per session, although given the progress made, extra cases
will now be added to some lists. The start time for some orthopaedic theatre lists has
also been brought forward. Mr Beveridge advised that the planned admissions unit
is now being used to undertake preoperative screening which will assist with the
situation.
Professor Alderson noted that although performance had improved, there was still
further work to do to address fully the issue of late starts. He asked how a late start is
defined. Mr Kirby highlighted that the real issue with theatre utilisation lies at the end
of the day, rather than at the beginning where late starts now account for only a
small loss of theatre time. Professor Alderson asked whether cancellation rates
associated with poor utilisation were measured. Mr Kirby advised that very few
operations are cancelled due to a lack of time at the end of the session. Professor
Alderson asked whether briefing lists are used at the start of each session. Mrs
Bromley advised that they were, although there was more work to do to ensure that
they are used rigorously and consistently. Dr Rasanayagam advised that a team
brief and debrief system is to be introduced, although observed that care needed
to be taken to ensure that these briefings did not delay the start of sessions.
Professor Alderson suggested that members of the theatre team should be asked to
attend promptly and as a mandatory requirement. Mrs Bromley advised that a
policy was being developed and implemented to add some structure to this
process. Miss Bartram asked from where the idea of a mandatory team brief
originated. She was advised that the Royal College of Surgeons had suggested that
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