Hospital team that’s slashing surgery backlog by treating its operating theatre like an F1 pitstop 

Dr. Imran Ahmad was pedaling his spin bike on a Saturday morning last year when he had a great idea, one that could help save the NHS.

As a consultant anesthetist at Guy’s and St Thomas’ Hospital in London, he suddenly envisioned a team of surgeons and operating room staff who could cope with the backlog of patients waiting for surgery.

It would function like a Formula One pitstop crew, performing fast and precisely planned operations with high-speed gearing.

And so the Guy and St Thomas High Intensity Theater Team (HIT) was born, and has proven to be just as potent as their racing inspiration.

On one astonishing day last month, the team completed eight prostate cancer operations at 5:00 p.m. Under the standard system, they would have performed just three, finishing at 7:30 p.m. It’s the most spectacular result in the 18 outings. of HIT (in different specialties, including joint replacements) to date.

“Our efficiency was pretty phenomenal,” says Dr. Ahmad proudly. The trick, he says, is in the planning: ‘Like at the race track, everyone has a role, everyone knows exactly what to do and does it very well.’

It’s encouraging to see amid the gloom surrounding the NHS status, and he fears it may buckle under pressure.

Frightening new figures reveal that more than seven million people are on the waiting list for NHS treatment; ambulance response times for serious incidents are more than double what they should be; and a record 32,776 people waited in the ER for more than 12 hours in September. Just a few of the many metrics that illustrate a health service on its knees.

Amanda Pritchard, chief executive of NHS England, recently said the health service was struggling to cover a £7bn shortfall in its budgets. But this isn’t just about money; disgruntled doctors have complained for years about the stifling bureaucracy of the NHS.

Dr. Ahmad was able to get management involved as he holds a position of authority, as clinical assistant director of the trust’s operating rooms.

The Formula One pit stop in your analogy is the operating room.

“I wanted surgeons to spend 90 percent of their time in theater operations,” he says. Currently, most only operate for 30-40 percent of their day because time is taken up by visiting the room and waiting while patients are under anesthesia or recovering after surgery.

That meant carefully optimizing all the processes around them to allow them to get on with the job. Ironically, Covid was the catalyst for this groundbreaking change. Dr. Ahmad found himself on the front lines of the covid pandemic as desperately ill patients, struggling to breathe, threatened to overwhelm intensive care. He came up with an emergency response, reorganizing his staff into fast-moving teams for intubation, tracheostomy, and intensive care.

Waiting lists for other treatments were already growing when she had her eureka moment on the stationary bike: “I thought, ‘Why don’t we do the same to handle the huge backlog of surgeries?’ ‘

The HIT teams he had in mind would be performing operations at a higher than normal rate, and that meant working on Saturdays, a day that typically doesn’t have surgeries booked in advance.

Dr. Ahmad felt that by choosing day-long surgeries that were relatively short, preferably less than an hour, they could create something of a medical conveyor belt. An added bonus would be that removing simple surgeries from the regular schedules would create space for more complex operations during the week.

It began by taking a close look at the ‘patient path’ and working out how it could be simplified, taking a group needing a similar hernia operation, for example, working out how the preparation for surgery could be done as a ‘one stop shop’. ‘. Blood samples, consent, and preoperative fitness checks can be performed together.

If you were to double the size of your usual team, they could perform four times as many operations.

Using two operating rooms at once could allow surgeons to “jump back and forth” between them. More nurses, assigned to clean and prepare the operating room for the next patient, have reduced the time it takes to complete their tasks from 20 minutes to five.

The incentive for staff is the payment of an additional day at a higher weekend rate. “And everyone gets paid until 5:00 pm, however early we finish,” says Dr. Ahmad. “That’s important because it reverses the norm in the NHS, which is that they give you extra work just as you’re finishing and don’t pay you for it.

“I also buy lunch, pizzas for everyone, and since we have extra staff, everyone gets a break. Most importantly, there is a sense of accomplishment. It’s fun because it’s a team thing. So far, HIT teams have worked on 18 Saturdays, in eight specialties, including knee and hip replacements and breast cancer surgery.

They have performed 344 operations and hope to bring that number to 400 by the end of the year.

Word of the team’s success has spread: Dr Ahmad has been asked by England’s Department of Health and the NHS to give a presentation, and hospitals abroad have contacted him to copy the idea.

“About 80 per cent of the seven million on the NHS waiting list would probably meet the HIT criteria,” says Dr Ahmad. “There are at least 1,000 hospitals in the UK, so if we could scale this, if even 50 or more could do it once or twice a month, imagine the dent we could make on that waiting list.”

Not all hospitals are suitable for establishing a HIT team: they need an additional operating room in case of emergencies, so they should have at least three.

The prostate cancer operation performed last month is the most complex that has been attempted so far. Four surgeons took turns performing the operations, which last 90 minutes and involve robots for precision.

Ben Challacombe, a consultant surgical urologist, carried out the operations in the shortest possible time between patients: just over 30 seconds. I put it on Twitter and it got 40,000 hits. People were commenting from all over the world. I had never seen anything like it.

HIT was a challenging day “but there was a sense of energy and togetherness,” he says. “There is a special smile at the hospital among the people who have been part of the teams, because you know you are doing something special.”

Patient care was foremost on his mind.

‘These men had cancer, so they needed support. The RNs who provided that were amazing, as was the administrative team who carefully scheduled appointments to make this work.’

Mick Jennings, 59, was one of the patients operated on that day. He was diagnosed in early September after a blood test revealed that he had an elevated PSA level, a marker for prostate cancer. “It was a bit of a shock… of course, you think of your family,” he said.

The eight men operated on that day were together in the preoperative period. “We all met again on the day of surgery and again when we had a post-op checkup, so we kind of became a gang of friends, and some of us are still in touch on WhatsApp,” added Mick. “Sending words of encouragement as we recover, and having those kindred spirits has been a good thing for all of us.”

A month later, Mick, an anesthetist at nearby Lewisham Hospital, is making a good recovery and contemplating his return to work.

He agrees that other hospitals would do well to replicate the HIT initiative.

“It shows that if you listen to people who are in the health service and empower them to follow your ideas, it can work very efficiently,” he says. “If you ask clinical staff at any hospital what’s wrong with the service, they’ll give you an honest answer, and they may have a good idea of ​​how to fix it.”

The best sleeping position for you

This week: sleep on your left if you have heartburn

Heartburn, also known as acid reflux, is caused by stomach acid backing up into the esophagus. A Dutch study published in the journal Brief Communication: Esophagus earlier this year found that while reflux occurs in all sleeping positions, in right-side sleepers, acid remains in the esophagus for an average of 90 seconds; on their backs it remained for 76 seconds, but when they slept on their left side it disappeared in an average of 35 seconds. This reduces the risk of symptoms that disturb sleep and reduces the risk of damage to the esophagus that can increase the risk of esophageal cancer. The reason for this is still being studied.