Key Thomas, Reid Gavin, Vannet Nicola, Lloyd John, Burckett-St Laurent David
Orthopaedics, Royal Gwent Hospital, Newport, UK.
BMJ Open Qual. 2019 Feb 18;8(1):e000515. doi: 10.1136/bmjoq-2018-000515. eCollection 2019.
The efficiency of trauma lists when compared with elective orthopaedic lists is a frustration of many orthopaedic departments. At the Royal Gwent Hospital, late start times affecting total operating capacity of the trauma list were recognised as a problem within the department. The design team aimed to improve the start time of the list with the introduction of the 'golden patient' initiative. A protocol was agreed between the orthopaedic, anaesthetic and theatre staff where a 'golden patient' was selected for preoperative anaesthetic assessment by 14:00 the day before surgery and sent for at 08:15 as the first case on the trauma list. Baseline data was collected over a month. Two Plan-Do-Study-Act (PDSA) cycles were completed, one on the month the 'golden patient' initiative was implemented and one 4 months after the change. All data was collected from the Operating Room Management Information Service theatre system for the trauma theatre at the Royal Gwent Hospital. Results demonstrated significant improvement in patient arrival time in the theatre suite; PDSA1 by 33 min (p≤0.001) and PDSA2 by 29 min (p≤0.001) and an earlier start of the first procedure; PDSA1 by 19 min (p=0.018) and PDSA2 by 26 min (p≤0.001). There was also increased mean operating time per list (PDSA1 +16 min and PDSA2 +33 min), increased total case number (PDSA1 +20 cases and PDSA2 +36 cases) and reduced cancellations (PDSA1 -2 cases and PDSA -5 cases) compared with our baseline data. We demonstrated that the introduction of a 'golden patient' to the trauma theatre list improved the start time and overall operating capacity for the trauma list. Continuing this project, we plan to introduce assessment of all patients with fractured neck of femur in a similar way to the 'golden patient' to continue improving trauma theatre efficiency and reduce case cancellations.
与择期骨科手术安排相比，创伤手术安排的效率让许多骨科部门感到沮丧。在皇家格温特医院，该部门认识到影响创伤手术安排总手术量的延迟开始时间是一个问题。设计团队旨在通过引入“黄金患者”计划来改善手术安排的开始时间。骨科、麻醉科和手术室工作人员商定了一项协议，即选择一名“黄金患者”在手术前一天14:00前进行术前麻醉评估，并在08:15作为创伤手术安排的第一例患者送去手术。在一个月的时间里收集了基线数据。完成了两个计划-实施-研究-改进（PDSA）循环，一个在实施“黄金患者”计划的当月，另一个在改变后的4个月。所有数据均从皇家格温特医院创伤手术室的手术室管理信息服务系统收集。结果表明，患者到达手术室的时间有显著改善；PDSA1提前了33分钟（p≤0.001），PDSA2提前了29分钟（p≤0.001），并且第一个手术的开始时间更早；PDSA1提前了19分钟（p=0.018），PDSA2提前了26分钟（p≤0.001）。与我们的基线数据相比，每个手术安排的平均手术时间也有所增加（PDSA1增加了16分钟，PDSA2增加了33分钟），总病例数增加（PDSA1增加了20例，PDSA2增加了36例），取消手术的情况减少（PDSA1减少了2例，PDSA2减少了5例）。我们证明，在创伤手术安排中引入“黄金患者”改善了创伤手术安排的开始时间和整体手术量。继续这个项目，我们计划以类似于“黄金患者”的方式对所有股骨颈骨折患者进行评估，以继续提高创伤手术室的效率并减少手术取消情况。
