The Renal team started clinical Microsystem Improvement work in November 2012. The original plan was to start with one of the renal access surgery lists and to review the processes and current practice in order to improve the efficiency of the list and ultimately produce more capacity for patients with kidney disease waiting for vascular access surgery. The team included regular renal theatre staff as well as representatives from TAU, Recovery, Renal Unit F floor and Peter Moorhead dialysis unit.
A multidisciplinary team have been meeting to review the data and explore opportunities. Using the microsystem 5Ps framework the team gathered and analysed data from various sources and mapped the vascular access patients’ pathway from the decision to admit to theatre discharge.
To provide safe, effective, timely, efficient, equitable and patient-centred care for patients with a kidney related condition
Patient feedback was very positive:
“Everybody was kind, explained everything and did it in a very professional way. Anaesthetist and surgeon didn't use medical terms, so I could understand all their explanations”“Good kidney service! 100% goes into it”
- The start and finish time of lists
- Reasons for delays and cancellations on lists
- Time between cases on theatre list
- Number of cases on the theatre list and on day cancellations
Data analysis and discussions led to the conclusion that before making plans to increase the number of planned cases on the list the team had to work on the reduction of 16% on-day cancellation rate as one of the main reasons for on-day cancellations was lack of time in the list. Main themes for improvement were identified as delays at the start of the list and also delays between cases.
New scheduling - The team is trialling a new scheduling in order to reduce the turnaround time between the first two cases. An extra member of staff for the first half of the list helps with setting up the trays, transporting the patients etc. TAU aims to get first two patients ready by 8.15
Preparation the day before - Peter Moorhead unit now makes sure that Monday list patients who come to dialyse the day before have their bloods taken their so that if necessary appropriate changes on the list can be done on Monday morning and the list does not get delayed.
Transport - As some of the delays are linked to the transport related issues, the team is trialling a new system where some patients are brought on the day of the surgery by taxis rather than ambulance service.
Bed pressures meant that the plan wasn’t precisely followed every week, but improvements can already be observed, including:-
- increased number of cases per list
- earlier start and finish times
- reduced turnaround times
- improvement in the cancellation rate and reasons for cancellation
“I feel very positive about the change. When the list runs as it should, it feels much better, although there has been some frustration due to pressures outside our control”
“It was possible to resolve some of the problems as several microsystems were working together”
“The success does depend on who is in theatre and on the regularity of the team working together”
Plans for the future
The team plans to continue with testing the changes and is discussing spreading some of the practices to a similar list.