1. Ophthalmology: Seamless Surgery Connect
Friday 23rd March 2018

2. Overview: Examples of actions taken to reduce on day cancellations
Ongoing/future plans
Questions/discussions

3. Weekly Theatre Meeting
Multi-disciplinary
Regular/dedicated session
Retrospective and prospective data
Full RCA of all list/on day cancellations
Forum for raising any theatre issues
Monitors performance

4. Northern General Eye Centre
Northern General Eye Centre due to open May 2018
Bespoke unit built specifically to allow introduction of Sheffield Cataract Pathway
One Stop Clinics
Microsystems theatre process
8 patients per list (33% increase)
Patient centred

5. On-day Cancellations due to Blood Pressure Sept ‘15-Jan ‘17
New BP policy introduced here
Sam -
Aim of the introducing this policy is to reduce patient cancellations on the day due to BP.
We had been cancelling patients because of concerns about per-operative (non-ocular) events, e.g. stroke. It seemed to be tradition that BP was measured on the day.
So we devised a blood pressure policy.
Circulated to OSCCA staff for their processes to be amended where required.
Policy now means that we have a normal BP reading from the GP or at pre-assessment within a 12-month period which is clearly documented. Patient is therefore fit for surgery, and BP is not rechecked on the day of surgery.
Sustaining the reduction to 0 cancellations for since May 2016.
Also introduced diabetic policy which similarly reduced on day cancellations to zero
Also complex patients now operated on by surgeon who listed them for surgery to remove cancellations due to differences of opinion
Reduced average from 1 patient per week to 0.1 patients per week

6. Diabetic Policy Policy introduced to prevent unnecessary cancellations
No cancellations since it was introduced in September 2016

7. “Complex” Patients New policy
All “complex” patients operated on by listing surgeon
Removed cancellations due to differences in clinical opinion

8. Patient Experience Gemma -
Produced with help from the Trust’s Communications team and also an external company.
We also play the animation on loop in our Cataract pre-assessment area.
Our intention is to reduce assessment time to 30 minutes as soon as we are convinced most patients have viewed the clip.
So far only 23 have been returned and this number is not enough to introduce changes.
Patients who have viewed the animation have given positive comments.
Patients have commented that they are less anxious after viewing the animation, and also that it is educational.

9. e-Theatre Lists Gemma - Benefits:
Session Date
Start Time
Theatre
Select Theatre
Surgeon
Select surgeon
Anaesthetist
Hospital No
Surname
First Name
Sex
Ward
D/C, O/N, IP
Procedure/Operation
Surgical Mins
Anaes
Transport
Post-Op Date
Comments
Choose Option
Select
Gemma -
Benefits:
Lists are accessible and located centrally
Lists are legible and updated constantly
Lists are shared safely and efficiently
Audit trail
Reduced the need for paper and means admin can work remotely away from clinical staff without preventing effective communication.
Standardising
Lists are kept together “by year” and split into weeks

10. ePAQ
80 Ophthalmology patients have used ePAQ-PO in the last year on J2, saving 80 pre-op slots
Good feedback from POA about sending appropriate patients
11 patients used ePAQ-PO with oculoplastic pre-op nurses to increase pool of ‘ready for surgery’ patients
Sam -
Send fit and well patients on no medications directly from clinic.
Ran some sessions locally in our pre-assessment area to pool long waiter Oculoplastic patients for surgery.
Excellent engagement from consultants and nurses with ePAQ within the department. Within Oculoplastics, one consultant led on a morning’s ePAQ education session with clinical and nursing colleagues.
We have realised that not patients are suitable for ePAQ – for e.g., Cataract patients are currently excluded because this cohort of patients have dilation drops when they attend clinic which means they would be unable to then use a computer.

11. Patient Reminder Calls
We use the Trust’s SPA team, who telephone patients a few days before surgery to check they are fit and will be attending.
Includes all Ophthalmology consultants and all Day Case wards.
Since February 2017, on-day surgery cancellations have reduced
6.3% to 5.1%
Sam

12. In-patient report
Report generated Mon/Wed/Fri to highlight in-patients due for surgery or clinic apt
Jan 17-Oct 17, 71 slots were re-booked that would have likely been clinic DNAs or surgical cancellations on the day
197 confirmations were made that wards would bring patients, serving as a reminder to avoid DNAs
45 patients were cancelled making theatre/clinic aware in advance

13. Listed for Surgery – Patient information leaflet Alturos
Ongoing/future plans
Listed for Surgery – Patient information leaflet
Alturos
TheatrePro/Seamless Surgery Dashboard
All day theatre lists e.g. VR
Listing rules e.g. glaucoma service
Gemma -
Patient information leaflet – the aim of this is to...
Inpatient report trial: process regarding patients who flag up on Lorenzo as being inpatients to ensure their surgery is cancelled.
Alturos: working closely with Martin Plura to ensure surgical minutes are reflected accurately reflected on ORMIS. Initial implementation, and now monitoring, with aim to review in July.
TheatrePro: targeted incremental improvements.
Late starts/early finishes: investigation and audit of. Highlights recurring patterns which we can target.
Use of OSCCA tool:
Able to closely trial and review week-by-week increasing patient numbers on lists where they look to be under-utilised.
VR all day theatre lists: clear split of elective/emergency patients. Seen improvements in theatre utilisation of planned routine lists. Next steps: continue to work alongside OSCCA colleagues to develop further with same anaesthetist/theatre staff all day.
Exclusion of emergency lists from theatre utilisation analysis on the OSCCA tool.

14. Double Award Winning!! Seamless Surgery Awards July 2017
Theatre Flow:
Cataract Microsystems Team
Also, Theatre and Seamless Surgery team shortlisted for Best Ophthalmology Team for the national Ophthalmology Honours Bayer awards next week.
Overall Seamless Surgery Team:
Ophthalmology & Theatres Seamless Surgery Team

15. Bayer:Ophthalmology Honours
Best Ophthalmology Team