Page last updated at 00:00 GMT, Sunday, 1 November 2009

Making operations smoother and safer

By Jane Elliott
Health reporter, BBC News

Lists are better run under the new system

At first sight an airline pilot, a car plant worker and a hospital surgeon would appear to have little in common.

But the NHS is learning from the aviation and automotive industries as it introduces new safety protocols to reduce the risk of accidents in the operating theatre.

Whether it is hitting a tropical storm at 36,000 feet or negotiating an expected emergency in the middle of open-heart surgery, advance planning and a calm and ordered environment can make all the difference.

It is a message NHS chiefs are keen to disseminate across the health service, and they have made a start with a new scheme from The NHS Institute for Innovation and Improvement called 'The Productive Operating Theatre'.

Good results

The early results from the six trial hospitals have been positive.

Trevor Dale, a retired airline pilot, who helped advise the test sites, said even little changes could make a big difference.

One 5-6 minute briefing could save us up to an hour a day
Janet Henry

"If we knew we would be flying through turbulence we could plan for that in advance," he said.

"We could then brief the cabin crew in advance, rather than waiting until they had the trolleys ready to serve the drinks and meals."

He said that operating staff could ensure they were similarly prepared.

"Things such as getting equipment ready and making sure that if a procedure means there is likely to be significant blood loss that there are cross-matched supplies ready in advance."

These simple things seem obvious to outsiders, but health workers admit that without an overview little things such as extra blood, ensuring patients are given anti-blood clot stockings and blood thinning drugs can slip through the net.

Professor Lord Darzi, the former health minister, said Productive Theatre, launched across the NHS in England in September, offered much.

"As a surgeon I know how vital a role a well organised operating theatre plays in ensuring a calm setting in a high pressurised working environment," he said.

"The operating theatre is a place where lives are transformed and saved and by taking simple steps to optimise the working environment, and where staff can continuously improve the quality of patient care."

Learning from industry

Health workers found simple things like holding a briefing meeting each day before operations start - and a de-brief at their end - can make a real difference.

Some have also implemented a check list system for each individual patient.

And in some hospitals the time taken to get patients to and from theatre has been sharpened up.

Janet Henry, theatre manger/matron at the West Middlesex University Hospital Trust, said her hospital had noticed considerable time savings.

Check list
Patient details are extensively checked

"One 5-6 minute briefing could save us up to an hour a day," she said.

She said staff focused on making little changes, such as juggling lists to ensure the right equipment was ready for each operation.

"We had equipment for keyhole surgery, but because of the increase in this type of surgery there was increase in pressure on it.

"So we discussed who had priority over the equipment and changed the list, rather than waiting until the patient was on the operating theatre and then realising there were going to be delays."

Hugh Rogers, a consultant urologist and a senior associate at the NHS Institute for Innovation and Improvement, said he too had noticed great improvements.

He said the fact that the health professionals involved in a patient's care came together to talk things through was a real step forward.

"We did not really do that before, but now everyone knows what is going on," he said.

"Everyone is on the same page. As a result everything runs really smoothly and there are no surprises."

For instance, a group meeting previewing one morning's schedule for surgery revealed that a particularly complicated procedure was due up first.

By juggling the list around the team was able to slot in another case while the anaesthesia was prepared for the longer procedure.

Production line

Mr Rogers said his team had been particularly inspired by the concept key to any good motor industry - the smooth production line.

But instead of putting car components together, his team was focused on getting patients to and from theatre in the most effective fashion.

"We try to avoid the risk of cancelling the operations because of overruns," he said.

"For instance, in orthopaedics we have found that the best time to send for the patient is the minute they start to close the wound."

Claire Bradford is theatre matron at the Royal Devon & Exeter NHS Foundation Trust, another of the pilot sites.

She said the introduction of individual patient checks had had a transformative effect on the working day.

"Everybody now expects it to happen and we are prepared for every eventuality," she said.

"It does make the day go better and we have avoided error."

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