NHS High Intensity Theatres.

I had an op this week as a day case on a Saturday, in fact the Saturday before a bank holiday. I think we were all having similar procedures

This isn't 'new' or 'a breakthrough'. Just dressed up differently. Over the years NHS theatres have utilised a number of strategies to cut backlogs.

This one isn't too disimiliar to an initiative I was involved in several years ago. 'Waiting list initiative' lists where carried out most Saturdays. Enhanced pay (2 or 3 times hourly rate for nurses) was the 'carrot'.
The surgeons where paid per patient. So conflict was there from the start. Surgeons would sign up to complete say 30 day surgery operations in a day and try to get through them as quickly as possible (usually before the rugby started in the afternoon: this was in Wales!). Nurses, giving up their Saturday, would want to stay for as long as possible to make it worthwhile!

These kind of lists are not for the faint hearted. They are fast paced, labour intensive and stressful: to get through as much as they quote requires three or four times as many staff as usual. The extra staff come from existing staff numbers signing up for 'overtime'. This is not sustainable in the long term and staff who regularly 'volunteer' for these lists do so generally to earn extra money. It has been proven to increase sickness rates in the long term and consequently reduce safe staffing levels at other times.

Generally departments have (non-enforceble) policies which state if you are off sick during the week of your overtime shift you cannot then say you are fit and well to come into the extra Saturday shift you have signed up for (a common 'trick'). Likewise if you are already a part time worker you do not get paid the enhanced rate until you have worked over the hours of a full time work pattern.

Also you will find that the staff that are attracted to these initiatives are younger and less experienced. Us 'oldies' have seen it/done it before. My time off is far more precious than 'extra' income.

Safety checks and balances still have to be carried out, instrument and swab counting: once at the beginning, twice at the end of every operation. Cleaning, bagging up and correctly labelling waste. Setting up for the next procedure cannot take place in the same area as the clearing up of the previous one, so often, however efficient you try to make it if the physical space had never been thought through properly you still have to wait until things are cleared and cleaned away before you can start to prep for the next case. It all takes time.

The department I currently work in have a 'super Saturday' initiative...................... absolutely nothing new.

It's the same old thing: money talks, pay people enough and they will come............

I'd like to add that my experience comes from a long time theatre nursing perspective. I do not speak for the medics.

And it all comes from the best of intentions but it's never as simple or breakthrough as the press like to make out.

What exactly is ‘rocket science

It sounds really old fashioned like something from the 1950s.

Do we still call them rockets?

I expect today we would call it aerospace engineering and spacecreft astrodynamics

It could work for simple outpatient procedures. But where are they going to get the additional doctors and nurses from to run these double theatres?

Also having watched the BBC Hospital programme - many operations seem to get cancelled because there are no beds on wards and/or intensive care. How are they going to increase capacity to overcome this issue?

Unless I’m missing something, this approach will only work in hospitals which have a lot of theatres suitably equipped for whichever procedures they were running the HITT lists for. If a hospital has, say 10 theatres, typically they are designated to specialties, so eg three would be orthopaedic, three surgery, one ENT, one Gynae, one urology, one ophthalmology. Each specialty has very different equipment needs for imaging and instruments, so you couldn’t turn a gynae theatre into an orthopaedic theatre without major investment, and only then if the theatre had space to house both sets of equipment. Then you factor in the emergency workload, so you need to have theatres available at all times to cope with RTA, ruptured aneurysms, eye injuries etc. etc.
I know from experience, there isn’t a magic bullet to solve waiting list queues, it takes a whole patchwork of solutions, different for every hospital, to maximise capacity. HITT is one (not new answer), and is applicable in very specific circumstances, generally in large sites with a dedicated theatre suite for each speciality.

I thought helpful for those DM phobics

OldFrill

Here's how it's been put into action, very effectively
www.guysandstthomas.nhs.uk/news/nhs-staff-find-innovative-way-tackle-surgery-waiting-lists

Very much as I posted in the OP.

Here's how it's been put into action, very effectively
www.guysandstthomas.nhs.uk/news/nhs-staff-find-innovative-way-tackle-surgery-waiting-lists

That's what the article said is happening NannyC1 two theatres with two teams working in tandem. One senior surgeon doing the tricky bits and junior surgeons doing the rest. The medics seem to be in favour.

For this to work,there would need to be 2 teams of theatre staff, or double theatres. How a team can clean a theatre in the time suggested and then go into another theatre is beyond me. I worked as a Theatre Sister for 27 years so I do know what I'm talking about. The Surgeon needs to take a breath before going on to do another case. Where is the time allowed for this I wonder. When we have robots operating this could work fine but not until.

I've had several day procedures done at the weekend, it's a bit of a myth that surgeons etc only do emergencies at the weekend. My daughter is an anaesthetist, the hospital where she currently works is not using all their theatres because of staff shortages.

argymargy

I’m not clicking through to the Daily Mail. Could you give us a clue what the “breakthrough” is?

😂😂😂

Also wondered about hygiene given only a few minutes allowed to clean between patients.

>After one patient's operation is completed, the second is brought in and has already been anaesthetised

Sounds like my op at UCLH a year ago, though there was just one team and one theatre. I was tubed up in an anteroom, chatted for a bit then "looks like they're nearly done with the last one - sleepy time!" and wheeled in. I don't think there was much wasted time. Don't know if 'my' anaesthesiologist stayed with me throughout or handed me over to the theatre one.

Beware of doors in hospitals decorated with Disney stickers. Scary 'procedures' lie behind them!

I had X-rays done 8.30am on a Saturday morning over August bank holiday. The staff were working flat out all three days to catch up. Wonderful.

Well planned and run efficiently, I think it's a good idea.

Like any business things are made ready for the one who actually does the work, no waiting around doing nothing.

Patient is made ready, all minutia accomplished, surgeon comes in after patient is asleep, does the surgery, changes/cleans/sterilizes, moves on to next person. What's not to love about efficiency?

Sounds efficient. My only concern would be whether it would overtax doctors and other staff. Heard this fast moving system described on the news yesterday as like a pit stop in Formula 1. Wouldn't want to take that analogy too far.

My 13 year old granddaughter is having major surgery next week - I’d hate to think the aim of the day was to fit as many operations in as possible!

Well, this is one way of reducing waiting-lists.

Another is scrapping the five-day week, which is what Danish hospitals are doing right now with teams of surgeons and theatre nurses and anaestesia teams working week ends on routinge procedures, instead of operating theatres being closed at weekends for anything apart from emergencies.

Obviously, theses teams have time off during the week instead of at the week-end.

this would be fantastic if they rolled this out with all hospitals in the uk, but you need the surgeons to give up some of the private patients that they see at the weekend.

I'm sure this has been done in the past - years ago, well before Covid so no idea why it ground to a halt

Why so rude?

Several letters in today's Times from surgeons who used this system effectively in the past.

Didn’t Geoffrey Robinson try to get surgeons to do this years ago? I remember a programme where he looked at the processes within the NHS and offered process changes but was defeated by the negative support from the surgeons. I’m sure someone will correct me if I’m wrong but I do remember feeling shocked at how little people wanted to improve the systems.

It appears that it’s weekends only, and monthly. The surgical team obviously operate within their specialism - breast reconstruction, prostate surgery, and knee replacements, are specifically mentioned in the article - and the “lead surgeon 'is bouncing from one theatre to the next doing the critical phase of the operation' with more junior surgeons assisting”.