One-Day Surgery - British Association of Day Surgery

P23
Improving Efficiency: A treatment
centre service evaluation
A Weigert, M Pernow
Chelsea & Westminster Hospital NHS Foundation
Trust
INTRODUCTION: Inefficient work practices in day surgery can
have a negative impact on patient care and satisfaction, cost
and staff morale. This evaluation was initiated by senior
nursing staff looking for areas of improvement in our Treatment
Centre. Absence of widely accepted standards precluded a
formal audit.
METHODS: We analysed all elective theatre lists for general
anaesthetic cases over a 4 week period with respect to start
and finish times, downtime between cases, on the day changes
to list order and cancellations. Arrival and waiting times in the
department were noted for each patient, and all critical
incidents and complaints were reviewed.
RESULTS: 1,111 theatre lists were included with a total of 492
patients undergoing procedures. 82 patients were cancelled
(14.3%). The commonest causes of cancellation were failure of
the patient to turn up (24.4%), being considered unfit for
operation (19.5%) and overrunning lists (15.9). 59% of lists
started more than 15 minutes later than scheduled, mostly
because patients were not ready. 44% of lists overran. Changes
to the order occurred in 62% of lists. Overall, changes to list
order were more common on lists that ran on time (65%,
average 1.7 changes per list), than on lists that overran (57%,
average 1.4 changes per list). This suggests that list changes
are unlikely to be the cause of overruns. Rather, it may be that
P24
Inadvertent Perioperative
Hypothermia in Day Case Patients:
‘Easily done but even easier to rectify’
H Chin, J Kim, V Hariharan
Milton Keynes Hospital
INTRODUCTION: Inadvertent perioperative hypothermia is a
common consequence of anaesthesia due to elimination of
behavioural responses to cold and impaired thermoregulatory
responses to heat loss. The National Institute for Clinical
Excellence (NICE) published new hypothermia guidelines in
April 20085 and since then, implementation, at best, has been
inconsistent. We aimed to audit our practice in the day surgery
setting and introduce measures to improve outcome.
METHODS: We conducted a retrospective audit looking at the
adherence rate of our practice to the national guidelines over a
period of 2 months in our day case unit. Data were collected
from patient notes and anaesthetic charts subsequently
analysed using Student’s t-test.
RESULTS: A total of 46 (pre-), 53 (intra-) and 99
(postoperative) day case patients were studied with their pre-,
intra- and postoperative temperature documented. Most
patients (93%) in the preoperative stage were normothermic
list changes can actually lead to more efficient patient
throughput and so avoid list overruns. 23.4% of lists finished
early, and 80% of these had cancellations. Downtime between
patients frequently exceeded 15 minutes (43%, 30.6%, and
24% in urology, orthopaedics, and gynaecology, respectively),
mostly reflecting time required for cleaning and complexity of
setup for the next case. Average waiting time in the department
prior to surgery was 2 hr 35 min (range 24 min to 8 hr 45 min). 4
critical incident forms were completed (0.9% of trust forms in
that period), relating to technical or administrative issues. Two
formal complaints were received, one relating to cancellation
on the day of surgery, the other to the attitude of a staff
member.
CONCLUSIONS: Our Treatment Centre is challenged by high
levels of cancellations, frequent changes to theatre lists on the
day, and a difficulty in having patients ready to start all lists on
time. This service evaluation has prompted a further
investigation into why patients do not turn up for their
procedures on the day, and valuable practical suggestions have
been made by nursing staff with regard to streamlining the
admissions process in the morning. This service evaluation has
generated debate with regard to setting standards relating to
waiting times for patients, the use of critical incident forms and
data collection and extraction issues for quality control
purposes. We are now considering the use of real time patient
survey devices to obtain additional feedback on our services. In
addition, this service evaluation is providing data for a wider
theatre improvement project undertaken at the Chelsea &
Westminster Hospital.
but only 26% were normothermic when they arrived in the
recovery room. Within the intraoperative group, temperaturemonitoring
rate was low (7–13%) and 34 (64%) fell into the
NICE high-risk category. However, only 43% (15/34) were
managed according to the guidelines. Postoperatively, 29%
were hypothermic. Hypothermic patients were found to have a
longer stay in the recovery room compared to the
normothermic group (45.5 vs. 31.9 minutes respectively, p =
0.013).
CONCLUSIONS: There was a poor adherence to NICE
inadvertent perioperative hypothermia guidelines in our day
case unit with only 24% normothermic postoperatively. The
causes are often common and multifactorial. Raising staff
awareness and increasing the availability of basic equipment
has since led to an improved outcome. Hypothermia adversely
impacts on both patient care and NHS resources. Therefore,
maintaining perioperative normothermia should be a high
management priority in all day case units.