Plastic Surgery in the South East of England

Background

In November 2022 and again in January 2023 The Surgical Consortium (TSC) were tasked by the Plastic Surgery department to assist in the backlog of patients awaiting an excision of a lesion on a long waiting pathway as well as urgent patients.

The Plastic Surgery department had tasked TSC with eliminating long waiters as well as increasing capacity for 2ww and urgent skin cancer referral patients that could not be accommodated in the week. TSC took full ownership of the whole patient pathway from auto-triaging patients according to procedure required, through to operating on those who required surgery and post-operative dressing clinic and follow up. TSC also managed the histology and the necessary ongoing treatment required including referral to MDT meetings.

The Challenge

Dermatology had a failure rate of circa 62% of all 2WW patients. Of those that had already been diagnosed with skin cancer, the majority were rapidly approaching the treatment breach date. Plastic Surgery department had an ever growing waiting list for malignant and benign skin conditions. 

The existing pathway meant that patients requiring surgery were added to the Trust’s waiting list for surgery, with the majority of ‘urgent’ patients waiting more than 6 weeks for surgery, and non-urgent patients waiting for anything between 3 months to over a year.

The Approach

TSC implemented technology and refined pathways where possible to allow for high volume parallel theatre lists. Auto-triaging of patients according to the procedure required using natural language processing allowed surgical time to be assigned for each patient and maximise efficiency of the lists as well as working on skillset of the assigned surgeon. As always, TSC adopt a hybrid patient led approach to booking appointments, through bot-assisted theatre appointments booking system combined with telephone calls to patients, TSC ensured the list and operating time was fully utilised whilst supplying the full theatre team for all theatres and dedicated co-ordinator. Theatres were comprised of both reconstructive cases and non- reconstructive cases.

As part of the full wrap-around care TSC always provide a plastics dressing clinic in subsequent weekends with no limits on the number of times a patient can attend. In addition to the procedure, TSC consultants also take full ownership of the histology results. Results are available for remote outcoming by the operating surgeon to ensure a rapid response to any histology result including MDT for whichTSC guaranteed minimum of one or two representatives. This wrap around care carried over from MDT in the form of TSC absorbing any patients requiring secondary procedures. All results are conveyed automatically to the patients and GP.

Throughout projects we look to run super weekends. These weekends are designed to be high intensity, resource efficient, and help with safe patient throughput. For
this project our super weekend included 5 dedicated procedure rooms operating on a combination of cases but included reconstructive and non- reconstructive cases. In parallel we continued to run a Plastics Dressing clinic for patients from previous weeks. In a weekend we had 89 patients listed for surgery and reviewed 29 in plastics dressing clinic