Surgical Robot Improvement Project Summary Jan 2016

Project Team

Chris Powell-Wiffen (Managerial Lead), David Yates, Patrick Dobbs, Neil Oakley, Jim Catto, Damian Doyle, Kathryn Dewick, Stephanie Andrew, Marie Summerly, Paul Summerly, Marian Hill, Jim Eustace, Richard Inman, Lynn Skelton, Kathryn Allred, Karl Brennan, Tim Sands (Service Improvement Lead).
 

Summary

The surgical robot is an extremely valuable asset for the trust and gives superior outcomes to patients over traditional surgical techniques. After successfully implementing the use of a surgical robot at Sheffield Teaching Hospital NHS Foundation Trust in 2013/14, the team were keen to maximise its usage. As cases performed using the robot tend to be long and complex, improving efficiency of the theatre list would not achieve time for an additional patient. The whole Urology MDT worked together to plan five successful trial days which extended the working day to enable the number of cases on the list to be increased by 50%, whilst maintaining, and in some cases improving, the cost effectiveness of the theatre list. Moving forward if this model can be replicated on all working days, a significant number of additional patients can be treated in a timely manner using this advanced technique.
 

Assessment

In March 2015, members of the service improvement team were asked to attend the existing surgical robot user group where the ambition to increase the usage surgical robot was discussed. The two main directorates using the robot are Urology and Gynaecology. It was agreed that existing data for surgical robot usage by these two directorates, from the previous year, would be analysed by the service improvement team and brought back to a future meeting.
 

Diagnosis

As waiting list pressures were greater for the Urology directorate the data analysis for this directorate was looked at in detail by the user group in April 2015. The data showed that an average Urology Robotic case time between April 2014 and March 2015 was 247 minutes. Therefore during the current Urology robot theatre lists, 8.30am to 5.30pm (540 minutes), two cases were currently being completed. It was clear that improving the efficiency of the theatre list alone would not enable sufficient time for an additional patient on the list. The group agreed they would trial increasing the length of a theatre list to allow for one extra patient. The impact of this would be widespread and so would require more staff to be involved in the planning of this trial. Following a larger group meeting in June 2015, with all potentially affected areas, such as theatre admissions unit and recovery, five trial days were planned where three patients would be listed onto an extended theatre list. The success of the trial would not only be reliant on completion of surgery for all three patients but also a number of other balance measures would be monitored, such as patient satisfaction, length of stay and impact on staffing, to ensure there were no negative side effects as a result of the trial.
 

Treatment

The trial days were spread over July, August and September 2015, with each completing the three patients. Patient surveys during the trial demonstrated high satisfaction with the RHH Urology experience. Early responses during the trial showed that waiting time to go to theatre for the third patient on the list was too long and so these patients were asked to attend the hospital later for the remainder of the trial. No staffing issues were noted as a result of the trial and length of stay for this group of patients remained the same.
 

Patients and Staff

During the trial, feedback was sought from patients and staff, the following comments were received:
 
Patients
Staff
“Excellent - a caring ethos throughout - most commendable”
“Service improvement involvement with the extended day trial was  invaluable they left no stones unturned”
“Efficient, caring and thoughtful”
“Staff very helpful, made me feel they were looking after me”
 

Benefits to date and future progress

The major benefit has been to the group of patients who were able to access this advanced treatment more quickly and to all those subsequent patients who ended up further up the waiting list as a result. The trust has also benefited from increased income from these lists from an average of approximately £9500 for the two case list to over £14000 for a three case list.
Following the trial, a review meeting was held in November 2015. All those involved in the trial agreed it had been a success and the extended day should be implemented on at least one, preferably two days a week. However it was agreed that for this to be sustainable, additional theatre staff would need to be appointed to be able to provide adequate cover to all theatre lists during the week. A plan was agreed to look at what staffing would be required and then a recruitment plan put in place, it was thought that recruitment and training would take approximately six months.
 

 
Further Information: Please contact the Service Improvement Facilitator Tim Sands on x68438 or timothy.sands@sth.nhs.uk for more information on this work.

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