Surgical Hub - First year performance figures: South Warwickshire University NHS FT

The plan:

To create a highly efficient orthopaedic surgical hub, dedicated to elective care patients, minimising waits for local patients and enabling the offering of mutual aid, whereby neighbouring trusts send patients to South Warwickshire University NHS FT (SWFT) for elective procedures. Self-financing, the hub would have to deliver a rapid increase in elective activity.

The results (after the first year):

Within six weeks of the agreement to proceed, a Vanguard theatre was commissioned, staffed with a Vanguard clinical team and linked to the hospital by a purpose-built corridor. 

Results over the next 12 months were remarkable. 1016 procedures, including 910 joint replacements were performed in the Vanguard theatre. That's an average of four procedures per day.

Key success factors:

Vital to the achievement of these fantastic performance figures is that no slots have been missed, enabling a usage figure of 100%.

1) The Layout. Positioning the Vanguard mobile theatre close to elective wards facilitated optimal patient pathways. The mobile theatre itself has a layout that adds efficiency, with the patient moving directly from anaesthetic room to theatre to recovery area, then along a corridor to the side, joining the constructed corridor back to the ward. 

2) Prioritisation of Staff Engagement. With this layout, surgeons feel they are in their own theatres. Staff, including transport, pre-op services, and a designated booking team were integrated into the hub, owning their patients along the care pathway. The surgical hub has had a positive impact on the working environment. Nurses prefer a busier ward and staff turnover has reduced since the opening of the Vanguard theatre.

Important for boosting engagement were:

■ Rapid installation and commissioning of the Vanguard theatre, and integration of the Vanguard clinical team. Soon after opening, Harkamal Heran, trust Chief Operating Officer, commented that the Vanguard clinical team are not a separate entity. The hub and all staff function as one cohesive service.
■ Promoting the hub as an on-going asset, into which investment would continue, if targets were met.
■ Embedding the ‘culture of not cancelling.' 

3) Optimisation of Patient Pathways to and from the Hub. The booking team calls patients near the top of the waiting list, asking them to fast, in readiness for a slot opening. Harkamal is delighted that working together, SWFT and Vanguard staff have maximised usage, "We have had, in the last couple of weeks, patients not being well but we have a whole group of patients who are ready to come in at short notice. So, we haven't lost a single opportunity to operate since the Vanguard opened." Rehabilitation commences while the patient is in hospital, minimising length of stay. 

4) Commitment to protecting elective capacity and activity. The Vanguard laminar flow operating theatre has been set up as a surgical hub for elective orthopaedic cases – not used for trauma or other specialities.

The results speak for themselves. Over a year, at a rate of four per day, 1016 procedures, including 910 joint replacements, were completed in the theatre. Orthopaedics saw a 30% reduction in length of stay. For RTT performance, SWFT climbed from 18th to 6th best trust in the country. The maximum expected number of procedures and financial contribution was achieved, without increasing the number of elective beds. 

Links:

• Orthopaedics delivered a 30% reduction in length of stay. 
• RTT performance: SWFT climbed from 18th to 6th best in the country. 
• Use of the Vanguard facility maintained the positive contribution made by orthopaedics, and contributed towards SWFT’s financial and operational resilience
• Targets for procedures and contribution were achieved, without increasing the number of elective beds.
• Mutual aid was provided to four trusts.
• Referrals increased by 10%, including out of area referrals because of SWFT's shorter waiting times.
• Theatre staffing improved as trainees completed courses, facilitating two extra general surgery sessions, and supporting additional dedicated paediatric lists and obstetrics sessions.
• Day case rates increased 4-fold compared with 2019.

• Watch a discussion with the trust's Chief Executive, Glen Burley, and Chief Operating Officer, Harkamal Heran 
• Watch a conversation with Tim Robertson, Consultant Orthopaedic Surgeon at Warwick Hospital 
• The white paper, drawing on the experience of SWFT: Reducing waiting lists, generating funds, improving lives: establishing a surgical hub
• The original case study