Neurophysiology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
Alliance Manchester Business School, The University of Manchester, Manchester, UK.
BMJ Open Qual. 2022 Jul;11(3). doi: 10.1136/bmjoq-2021-001808.
At the Walton Centre we conduct a relatively large number of complex and lengthy elective (booked) spinal operations. Recently, we have had a particular problem with half or more of these sessions finishing late, resulting in staff discontent and greater use of on-call staff.These operations require patient monitoring by neurophysiology clinical scientists. Before the surgeon can start the operation, in-theatre neurophysiological measurements are required to establish a baseline. We reasoned that reducing this set-up time would reduce the risk of surgery starting late, and so the whole session finishing later than expected.In this project we redesigned the neurophysiology parts of in-theatre patient preparation. We conducted five Plan-Do-Study-Act cycles over 3 months, reducing the duration of pre-surgery preparation from a mean of 70 min to around 50 min. We saw improvements in surgical start times and session finish times (both earlier by roughly comparable amounts). The ultimately impact is that we saw on-time session finishes improve from around 50% to 100%. Following this project, we have managed to sustain the changes and the improved performance.The most impactful change was to conduct in-theatre neurophysiology patient preparation simultaneously with anaesthesia, rather than waiting for this to finish; when we performed this with a pair of clinical scientists, we were able to complete neurophysiology patient preparation by the time the anaesthetist was finished, therefore not introducing delays to the start of surgery. A final change was to remove a superfluous preparatory patient-baseline measurement.This is a very challenging and complex environment, with powerful stakeholders and many factors and unpredictable events affecting sessions. Nevertheless, we have shown that we can make improvements within our span of influence that improve the wider process. While using pairs of staff requires greater resource, we found the benefit to be worthwhile.
在沃尔顿中心，我们进行相对较多的复杂和冗长的选择性（预订）脊柱手术。最近，我们遇到了一个特别的问题，即这些手术中有一半或更多的手术结束时间较晚，导致员工不满和更多地使用随叫随到的员工。这些手术需要神经生理临床科学家对患者进行监测。在外科医生开始手术之前，需要进行术中神经生理测量以建立基线。我们推断，减少这种设置时间将降低手术开始延迟的风险，从而使整个手术比预期的结束时间更晚。在这个项目中，我们重新设计了术中患者准备的神经生理学部分。我们进行了五个计划-执行-研究-行动循环，将术前准备的持续时间从平均 70 分钟缩短到大约 50 分钟。我们看到手术开始时间和手术结束时间都有所改善（都提前了大致相同的时间）。最终的影响是，我们看到按时完成的手术比例从大约 50%提高到 100%。在这个项目之后，我们成功地维持了这些变化和改进的绩效。最具影响力的变化是同时进行术中神经生理学患者准备和麻醉，而不是等待麻醉完成；当我们与两名临床科学家一起进行时，我们能够在麻醉师完成时完成神经生理学患者准备，因此不会导致手术开始延迟。最后一个变化是删除了一个多余的预备患者基线测量。这是一个非常具有挑战性和复杂的环境，有强大的利益相关者和许多因素和不可预测的事件影响手术。然而，我们已经证明，我们可以在自己的影响范围内进行改进，从而改善更广泛的过程。虽然使用一对工作人员需要更多的资源，但我们发现这样做是值得的。
