General Surgery in the South East of England

Background

In an integrated acute and community Trust serving 800,000 residents, they are the largest NHS organisation in the East of England.

In January 2023 The Surgical Consortium (TSC) were tasked by the general surgical department to assist in the backlog of
500 patients awaiting cholecystectomy or hernia repair, with particular focus on those over 78 weeks waiting time. With the success of Phase I, TSC were asked to help with eliminating a wider proportion of the backlog.

The Challenge

The General Surgical department had prioritised 500 patients to be seen by the end of March 2023 with wait times >78 weeks. TSC took full ownership of the whole patient pathway from receipt of the PTL. This included:

 - Validation and triage of the full PTL

 - All administration and booking of clinics and theatres

 - Reviewing patients 1st attendance in clinic and organising radiological and blood        investigations

 - Operating on those who required surgery.

 - All discharge letters to GP's, patients and ensuring the Trust systems were kept up to date and remained the authorative source of information.

The challenge was to continue with the highest quality of care whilst running lean theatres and clinics in parallel. TSC worked with the local radiology department and blood laboratory to effectively move forward all patients in the pathway.

The Approach

TSC worked on front loading clinics at the beginning of the project for two weekends to begin populating patient pool requiring surgery. This would then allow the remaining weekends to run parallel clinics and theatres and reduce those on the PTL waiting to be seen or operated on. Over the 74 weekend days of clinic, 3466 patients were reviewed in clinic whilst 906 patients underwent a surgical procedure over a 76 day period (38 weekends).

TSC worked closely with the local radiological department and blood laboratory to efficiently move these patients through the pathway and allowed the clinicians to remotely review and outcome results. During this time, TSC removed 2368 patients from the waiting list, far exceeding the initial numbers set. These patients included 1036 being discharged to the GP either on the day of the clinic or following investigation. Over this time, the RTT weeks of the patients under our care reduced from 83.80 on receiving the PTL, down to 37.47 by the end of March 2023.

Our teams conducted all administrative duties from booking the patients into clinic, phlebotomy clinics and theatre. TSC provided all staff for clinics, phlebotomy and a full theatre team including anaesthetist, ODPs, scrub and recovery. TSC also worked with the local team to complement the ward for smooth and efficient discharges of the day case patients. Only 48 patients were admitted over the project for an overnight stay.