SUCCESS STORY
Successful day surgery pathway
Creating a day surgery playbook to implement for NHS England
Key facts
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Blackpool NHS Teaching Hospitals, London, the United Kingdom
The British Association for Day Surgery (BADS) recommends that hospitals complete 60% of Vaginal Hysterectomy (VH) as day surgery. Only 2% of hospitals in England are reaching this recommendation.
The disparity results in burden on clinical time, resources, departmental budgets and hospital capacity, a particular concern during the COVID-19 pandemic.
VH completed as a day case procedure is considered to be as safe as an inpatient procedure with low readmission rates, particularly if emphasis is placed on pre-surgical planning and patient selection.
Patient satisfaction and safety can be enhanced if trusts had a practical guidance to establish a VH day surgery pathway which would result in the potential for patients to have less contact time in hospital and more time at home during the recovery period, with remote clinical support.
The playbook
Landscape
Blackpool Teaching Hospitals NHS Foundation Trust is one of only five of England’s 119 Trusts that has adopted VH as a default standard day procedure and the ambition was to create a blueprint of its success that could be followed by other Trusts to replicate a successful and sustainable day surgery pathway.
The playbook enables Trusts to utilize and adapt procedures established in Blackpool to establish their own pathway that can release bed capacity to support the increasing flow of elective surgery, minimize the contact time of patients within the hospital setting and reduce their infection risk, and assist in reducing waiting lists.
Scaled up and rolled out to gynaecology centres across NHS England, it could help Trusts significantly improve the volume of VH day case surgery. This could free up considerable bed and theatre capacity if complemented by efficient operational processes to maximize the use of capacity.
A significant number of additional procedures could also be completed
Through the adoption of vessel sealing technology, which can reduce procedure length and potentially enable an extra case per session.
Creation
The partnership and continued collaboration between the gynaecology department in Blackpool and the IHS team was critical to devising a playbook that could guide other Trusts to benefit from their experience.
IHS worked with the hospital’s gynaecology department and key leaders to capture learnings in a combined knowledge pool. Medtronic’s track record at building partnerships and pathways was instrumental in constructing an approach that could be tailored to each Trust to enhance their performance.
The Associate Medical Director and Head of the Hospital’s Obstetrics & Gynaecology department, Mr Eric Mutema, and his team worked in concert with Medtronic teams to identify the key enablers, risks, highlight case specific examples to guide the creation of an effective and deliverable playbook.
These insights provided the motivating force and content of the playbook and its Opportunity Quantification tool that calculates the estimated cost of the current standard and the future potential pathway scenarios based on the resource variables which differ between them.
Inside the playbook
Data capture and perioperative document templates can be adapted to allow the specific characteristics of each Trust to shape the scale of opportunity in relation to theatre throughput, bed capacity and resources, and establish the wider pathway to ensure patient preparation and recovery is optimized.
The playbook also includes an assessment of the potential for a remote patient monitoring and engagement digital platform within a new day case VH pathway. This could support patients with educational content and provide clinicians with important pre-admission information to make sure patients are ‘surgery ready’.
This can reduce the time required for face-to-face consultation and/or potential procedure cancellations, as well as increasing confidence for both the patient and clinician by keeping them informed and engaged.
A digital protocol also supports the monitoring of post-procedure symptoms and collection of PROMS for Trusts to demonstrate and measure outcomes.
Dr Mutema demonstrated the significant potential benefits of a VH day surgery pathway in terms of cost and resource savings to the health system at the NHS Providers conference 2020, chaired by British Association of Day Surgery (BADS), earlier this year. His team is also offering clinical mentorship in collaboration with Medtronic to supplement projects at other Trusts.
The playbook also features
Tools and project approach guidelines that support the implementation of significant opportunities for Trusts - using clinical mentorship and IHS consultancy expertise throughout the transition phase - and for their gynaecology patients.
The approach is collaborative with modelling and costing dynamics harmonized to local needs and an implementation that underpins the value it can bring to the health system and patients.
Curved jaw device solution
The Medtronic team supports Blackpool’s gynaecology team and other hospitals across the region utilize the Touch Surgery digital app technology to video record and annotate day case VH procedures utilising the LigaSure™ Curved Jaw electrosurgical vessel sealing device. These videos can be shared with other Trusts, via the Touch Surgery app, to upskill on the use of vessel sealing technology as an alternative to traditional sutures.
The new technology is more expensive than traditional sutures on a per surgical case basis but the reduced postoperative pain and bleeding can enable patients to be discharged on the same day of their procedure. The cost savings from a day case pathway can outweigh the added cost of the technology alongside having significant benefits for patient-reported outcome measures
Benefits:
- Consultancy support to define and implement the steps to achieve a successful day case VH pathway and align stakeholder expectations and objectives across the wider clinical team
- Quantify the opportunity based on local projected procedure volumes and use this to inform the business case
- A series of data gathering and perioperative information templates to support the pathway
- Clinical mentorship and complementary Touch Surgery procedure recordings to support adoption of LigaSure Curved Jaw technology
- Options to deploy Medtronic IHS consultancy expertise to design a digital protocol to embed across pre- and post-procedure phases of a day case pathway
Implementing vaginal hysterectomy as day surgery helps:
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