Theatre Refurbishment Programme City Road January 2015
Work streams Key actions 1 Theatre staffing Review of structure, roles and responsibilities 2 Service teams Developing service team leaders 3 Operating lists Review of scheduling and planning of lists 4 Admitted pathway Feasibility study, develop options for 1 st floor 5 Operational/Equipment Defined management of contracts & stock control 6 MEH private Identify service developments for private 7 Emergency admitted Improve the pathways to improve communication 8 Information Technology Review of software, systems and metrics available 9 Governance Review of policy, processes and information 10 Safety Team Brief and WHO checklists 11 Education & research Recruitment of Practice facilitator 12 Efficiency and Value Improve utilisation of theatre capacity 13 Performance Metrics Accurate reporting tools 14 Communication /Progress Reports /updates /user groups
Work stream 1- Theatre Staffing Agreed structure, roles and responsibilities Consultation undertaken with Clinical theatre teams Significantly improved performance management processes, absence management and appraisal management Administrative consultation planned January 2016 Implementation of e-rostering programme Work stream 2- Introduction of Service Teams Identified Theatre Service Team Leader roles and job descriptions agreed, banded and commenced January 2016 Each service team undertake a review of equipment and instrumentation requirements Each team leader attends service review meeting and service Governance meetings to understand the needs of the services
Work stream 3- Ordering and Planning of Operating lists Scheduling and planning of operating lists meeting held weekly Pilot project with a Surgeon and anaesthetist from each service, reviewing and ordering the operating list developed Local safety standards finalised describing the agreed process for scheduling and listing of procedures Commence pilot of planned order of operating lists Work stream 4 Pathway for admitted activity Review current pathways and confirmation of key weaknesses or non-compliances against guidance to admitted pathway Developed an outline schedule of accommodation for facilities Architect engaged to develop feasibility study and scope of service Measured survey, structural survey, review of M&E infrastructure Present feasibility study with option appraisal.
Work stream 5- Operational + Equipment Identified all maintenance and service contracts for theatres Introduction of material management processes in theatres with bar coding significant cost reduction in non-pay Development of new operating theatre timetable Annual review of equipment and instrumentation Finalise the move of maintenance and service Work stream 6- Moorfields Private Agreement for specific theatre to be made available to MEH private Specific team leaders identified to lead MEH private Reporting programme available for MEH private to review the utilisation of their lists New timetable developed and further discussions ongoing Scoping programme to review capacity and demand requirements
Work stream 7- Emergency Service A full service review and audit of the VRE service to establish the current resources and future opportunities Review of referral source to the VRE Clinic to ensure that referrals are triaged and signposted effectively Review of treatment and procedure options to ensure income captured throughout the pathway. Work stream 8- Information Technology Identified requirements for integration of PAS Silverlink and OpenEyes Installation of COW on wards to assist with communication and flow of activity Implementation of data and operational requirements for the successful integration between PAS and OpenEyes
Work stream 9- Governance Review of all local procedures and standard operating processes ensuring local safety standards are based on National Safety Standards for Invasive Procedures (NATSSIP S) Weekly Theatre meeting to discuss the responsibility's of adhering to the procedures and the impact on patients safety- all staff encouraged to report safety incidents and/or near misses Theatre representation to Infection control, Clinical Governance, Risk Management and Health and safety meetings feeding back to the theatre team Significantly improved responsibility and accountability from staff with clear job descriptions Ongoing review of local safety standards to ensure compliance against National Safety standards
Work stream 10- Safety Reinforce the use of the WHO checklist providing an accurate record of checks being performed delivers a written record of Procedural verification and site marking Sign in, time out and sign out Prosthesis verification Conformity with the Pre-operative Team Brief encourages all staff to express any concerns of planned procedures or patient safety issues with a debriefing session at the end Audit of Team brief undertaken, demonstrating improved compliance Infection control audit Health and safety audit Medicines Management audit- all demonstrate compliance Ongoing audit of Local safety standards Continued discussion with staff of responsibilities for the management of e.g. Prosthesis verification, equipment failure and prevention of retained foreign objects
Work stream 12- Efficiency and Value Significant improvement in management of theatre budget both pay and non pay Open day being undertaken for recruitment of group of staff wishing to work in theatres at City road- reduction of agency utilisation Programme to define reference costs per procedure Recruitment to fill staff vacancies via Open days Work stream 13- Performance Metrics Introduction of programmes for monitoring and reporting of activity: Theatre utilisation broken down by every session Starting time of both am and pm sessions Cancellation report for medical and non medical activity Audit of cancellations and DNA s to understand trends Audit of activity between VR elective and VR emergency activity
Work stream 14- Communications Communications board in City Road theatres updated monthly Monthly reports available for services and directorates of progress and utilisation Weekly scheduling and cancelation meeting at City Road including all service managers and service admission co-ordinators with P&I representative to discuss scheduling, utilisation and staffing issues Update provided at Clinical Governance half days and clinical service meetings Develop a Moorfields Theatre group for all theatres leads from City road and satellites to meet monthly to ensure consistency in standards and resolution of concerns ensuring best practise initiatives are communicated to all Development of a Moorfields Medical Theatre user group