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@seamlesssurgery #seamlessconnect18
Seamless Surgery Connect
Friday 23rd March 2018, 09:15 - 16:00
@seamlesssurgery #seamlessconnect18
@seamlesssurgery #seamlessconnect18
Welcome & Introduction
Miss Fiona Kew Clinical Director – Obstetrics, Gynaecology & Neonatology
and Clinical Lead for Seamless Surgery
Sheffield Teaching Hospitals NHS FT
@seamlesssurgery #seamlessconnect18 Agenda
Time Item Location
09:15-10:00 Arrival, registration, & coffee Postgrad Common Room
10:00-10:10 Introduction Miss Fiona Kew
Lecture Theatre
10:10-10:45 Seamless Surgery – Our Story Lecture Theatre
10:45-11:30 Breakout 1 Breakout Rooms
11:30-12:00 Mr Chris Blundell Lecture Theatre
12:00-12:45 Lunch Postgrad Common Room
12:45-13:30 Professor Mike Horrocks & Liz Lingard (GIRFT)
Lecture Theatre
13:30- 14:00 Professor Tom Downes Lecture Theatre
14:00-14:45 Breakout 2 Breakout Rooms
14:45-15:00 Coffee Postgrad Common Room
15:00-15:45 Breakout 3 Breakout Rooms
15:45-16:00 Reflections & Close Lecture Theatre
@seamlesssurgery #seamlessconnect18 Who’s here?
@seamlesssurgery #seamlessconnect18 Who's here?
@seamlesssurgery #seamlessconnect18
@seamlesssurgery #seamlessconnect18
Seamless Surgery – Our Story Paul Griffiths
Seamless Surgery Programme Manager
Dr Karl Brennan
Consultant in Neuroanaesthesia & Neurocritical Care
and Clinical Lead for Seamless Surgery
Sheffield Teaching Hospitals NHS FT
@seamlesssurgery #seamlessconnect18
“There should be much more emphasis on bringing about
improvement and change from within”
@seamlesssurgery #seamlessconnect18 Making connections
make 2 new connections….
share something about yourself… …and what motivated you to be here today
In 2 minutes
@seamlesssurgery #seamlessconnect18
9 million
Elective operations across the NHS in England per year
@seamlesssurgery #seamlessconnect18
414 million
Patient days spent waiting for surgery
@seamlesssurgery #seamlessconnect18
88%
Improvement in patient health as a result of a hip replacement
(PROMS Score, 2017)
@seamlesssurgery #seamlessconnect18
189
Reported wrong site surgery incidents in 2016/17 across the NHS in England
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90,000
Cancelled operations across the NHS in England per year - with a cost of around £180m
@seamlesssurgery #seamlessconnect18
20%
Proportion of the NHS budget spent on elective surgical care
@seamlesssurgery #seamlessconnect18
2012
@seamlesssurgery #seamlessconnect18
@seamlesssurgery #seamlessconnect18
@seamlesssurgery #seamlessconnect18
Spread it…
…at scale and at pace
@seamlesssurgery #seamlessconnect18
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22
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What is Seamless Surgery?
@seamlesssurgery #seamlessconnect18
“Continuous improvement work and projects, led by front line teams, using
improvement methodology. It is underpinned by principles of good practice,
with the aim of creating the best elective surgical pathways for all of our patients”
@seamlesssurgery #seamlessconnect18
“If you want to make true and lasting change ask the people who do the work”
Daren Anderson, MD VP/Chief Quality Office
Community Health Centre, Inc.
@seamlesssurgery #seamlessconnect18
Subject Matter Knowledge
Subject Matter Knowledge …of the basic to the things we do in life; professional knowledge.
Profound Knowledge …the interaction of the theories of systems, variation, knowledge, and psychology.
Profound Knowledge
How we do it…
@seamlesssurgery #seamlessconnect18
Profound Knowledge
Subject Matter Knowledge
Improvement
@seamlesssurgery #seamlessconnect18 Deming’s Lens of Improvement
@seamlesssurgery #seamlessconnect18
@seamlesssurgery #seamlessconnect18
Deming’s System of Profound Knowledge
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@seamlesssurgery #seamlessconnect18
Impact…?
@seamlesssurgery #seamlessconnect18
1800 more patients over 18 months
@seamlesssurgery #seamlessconnect18
@seamlesssurgery #seamlessconnect18
84.0%
86.0%
88.0%
90.0%
92.0%
94.0%
96.0%
98.0%
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
Oct
-16
No
v-1
6
Dec
-16
Jan
-17
Feb
-17
Mar
-17
Ap
r-1
7
May
-17
Jun
-17
Jul-
17
Au
g-1
7
Sep
-17
Oct
-17
No
v-1
7
Dec
-17
Jan
-18
% Within 18 weeks National v STH
% within 18 weeks (National) % within 18 weeks (STH)
Seamless Surgery Launch
20% reduction in median waiting times for surgery
@seamlesssurgery #seamlessconnect18
-£2,000,000.0
-£1,500,000.0
-£1,000,000.0
-£500,000.0
£0.0
£500,000.0
£1,000,000.0
£1,500,000.0A
pr-
15
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
De
c-1
5
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
Oct
-16
No
v-1
6
De
c-1
6
Jan
-17
Feb
-17
Mar
-17
Ap
r-1
7
May
-17
Jun
-17
Jul-
17
Au
g-1
7
Sep
-17
Oct
-17
No
v-1
7
De
c-1
7
Jan
-18
Feb
-18
Elective inpatient monthly income - variance against target
Income over-performance of £160k per month, from losses
of -£500k per month
@seamlesssurgery #seamlessconnect18
Feedback and the future…
@seamlesssurgery #seamlessconnect18
Pt Agrees Date
Production Control
Alturos
Fixed List 48hrs ePAQ-PO
Cancellation RCA
ORMIS 2 Wks
Core Th Team Th Flow
Escalation plans
Electronic Diaries
Reminder Calls
0.00
10.00
0 10Fully
Implemented Not Implemented
at all
Not Important
at all
Vitally
Important 158 Responses from 24 different
specialties/areas and 9 staff groups
@seamlesssurgery #seamlessconnect18
‘Huge improvement in understanding processes, working across directorates,
better communication, better understanding of one another's roles. Has created a value to
the operating services resource’
‘Lack of capacity in system will obstruct flexibility required to implement’
‘Implementation takes a long time’
‘Have finally reduced the number of on the day
cancellations’
‘It has greatly improved the running of lists on the day through
advanced planning’
‘Increased support to teams to make improvements, especially those finding it most difficult’
@seamlesssurgery #seamlessconnect18
Pt Agrees Date
Production Control
Alturos
Fixed List 48hrs ePAQ-PO
Cancellation RCA
ORMIS 2 Wks
Core Th Team Th Flow
Escalation plans
Electronic Diaries
Reminder Calls
4
6
8
10
4 6 8 10Fully
Implemented
Vitally
Important
@seamlesssurgery #seamlessconnect18
Leadership and Management Development
Organisational Development
@seamlesssurgery #seamlessconnect18
@seamlesssurgery #seamlessconnect18
Thank You – Any Questions?
@seamlesssurgery #seamlessconnect18
Now: Breakout 1
Breakout Room
Seamless Surgery in Sheffield – Sheffield Teaching Hospitals Postgraduate
Common Room
Reducing Surgical Site Infections & Improved Patient
Experience – St Georges Seminar Room 3
Seamless Surgery in Ophthalmology – Sheffield Teaching
Hospitals Seminar Room 4
Elective Care Team Sustainability Assessment Tool - NHSI Seminar Room 5
Well Prepared Surgery – Sheffield Children's Seminar Room 6
@seamlesssurgery #seamlessconnect18
Lunch Postgraduate Common Room
& Lobby Area @seamlesssurgery #seamlessconnect18
After Lunch: Liz Lingard & Professor Mike Horrocks from GIRFT in Lecture Theatre 2
Proportion of patients readmitted in an emergency within 30 days
for any reason following an AAA procedure by provider and
provider type: initial admission 01-Apr-2012 to 31-Dec-2014
66
EVAR procedure Open procedure
In-hospital mortality following any AAA repair procedure by
provider and provider type 01-Jan-2015 to 31-Dec-2015
67
(x10 variation)
Proportion of patients receiving a CEA procedure of any type within 7 days of referral to a Vascular service by provider and provider type 01-Jan-2014 to 31-Dec-2014
(x6 variation)
Median days from assessment to surgery for CEA repair by provider and provider type 01-Jan-2014 to 31-Dec-2014
(5-30 days variation)
Proportions of post-surgical destination ward type post CEA
procedure by provider 01-Jan-2014 to 31-Dec-2014
70
Adjusted in-hospital mortality or stroke rate of patients undergoing a CEA procedure during the inpatient spell of the procedure by provider and provider type 01-Jan-2014 to 31-Dec-2014
(x10 variation)
Adjusted in-hospital mortality or stroke rate of patients undergoing a CEA procedure during the inpatient spell of the procedure by provider and provider type 01-Jan-2014 to 31-Dec-2014
(x10 variation)
Adjusted in-hospital mortality or stroke rate of patients undergoing a CEA procedure during the inpatient spell of the procedure by provider and provider type 01-Jan-2014 to 31-Dec-2014
(x10 variation)
Activity counts of lower limb revascularisation procedures by procedure type, provider and provider type 01-Apr-2014 to 31-Mar-2015
Average length of stay for elective lower limb bypass procedures by provider and provider type 01-Apr-2014 to 31-Mar-2015
Diabetic Non-diabetic
Average length of stay for elective lower limb bypass procedures
by provider and provider type 01-Apr-2014 to 31-Mar-2015
74
- twice as long if admitted as an emergency
Non-diabetic Diabetic
Recommendations
• Engage of profession with management
• Fully develop the Network Structure (for Vascular)
• Develop as an Urgent Specialty with fast through flow
• Engage with Spoke hospitals, clinicians and managers
• Ensure all patients have same priorities
• Share pathways and timelines with other teams
• Adequate staffing and facilities
• Consider 7 day operating with cases fed into facilities
• Arrange angioplasties to reflect the urgency and facilities
Continued
• Full pre-admission work-up
• Prehabilitation where possible
• Early discharge planning
• Identify likely re-admitters (frailty score)
• Early medical contact post-op
• Phone contact for worried patients
• Review your litigation cases and learn from them
Local Issues
• Hubs, how many and where
• Combining teams
• Particular geographical problems
• Ensuring spokes are on board
• Shared pre-op work-up
• Accept post-op transfers
• Ensure links for referrals and MDT’s
• Regular reviews of data and outcomes
Questions
78
Mike Horrocks
GIRFT Vascular Clinical Lead
GIRFT Clinical Ambassador for South West Hub
E
M
Liz Lingard
North East, North Cumbria & Yorkshire Hub Director
M 07730374650
@seamlesssurgery #seamlessconnect18
Great care is discovered, not decided
Professor Tom Downes
Clinical Lead for Quality Improvement
Consultant Physician and Geriatrician
Sheffield Teaching Hospitals NHS FT
@seamlesssurgery #seamlessconnect18 Learning from failure
@seamlesssurgery #seamlessconnect18 Pyjamas
@seamlesssurgery #seamlessconnect18 20% reduction in LOS
@seamlesssurgery #seamlessconnect18 George
@seamlesssurgery #seamlessconnect18 Reduced hospitalisation of 40,000 bed days
@seamlesssurgery #seamlessconnect18 Sepsis
Proportion of all AAA procedures that are repaired by EVAR by
provider and provider type 01-Apr-2014 to 31-Mar-2015
64
Proportion of Aneurysms repaired by EVAR
65
Proportion of all unruptured (elective) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015
(x2 variation)
Proportion of all ruptured (emergency) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015 (x10 variation)
Proportion of patients readmitted in an emergency within 30 days
for any reason following an AAA procedure by provider and
provider type: initial admission 01-Apr-2012 to 31-Dec-2014
66
EVAR procedure Open procedure
In-hospital mortality following any AAA repair procedure by
provider and provider type 01-Jan-2015 to 31-Dec-2015
67
(x10 variation)
Proportion of patients receiving a CEA procedure of any type within 7 days of referral to a Vascular service by provider and provider type 01-Jan-2014 to 31-Dec-2014
(x6 variation)
Median days from assessment to surgery for CEA repair by provider and provider type 01-Jan-2014 to 31-Dec-2014
(5-30 days variation)
Activity counts of lower limb revascularisation procedures by procedure type, provider and provider type 01-Apr-2014 to 31-Mar-2015
Average length of stay for elective lower limb bypass procedures by provider and provider type 01-Apr-2014 to 31-Mar-2015
Diabetic Non-diabetic
Average length of stay for elective lower limb bypass procedures
by provider and provider type 01-Apr-2014 to 31-Mar-2015
74
- twice as long if admitted as an emergency
Non-diabetic Diabetic
Recommendations
• Engage of profession with management
• Fully develop the Network Structure (for Vascular)
• Develop as an Urgent Specialty with fast through flow
• Engage with Spoke hospitals, clinicians and managers
• Ensure all patients have same priorities
• Share pathways and timelines with other teams
• Adequate staffing and facilities
• Consider 7 day operating with cases fed into facilities
• Arrange angioplasties to reflect the urgency and facilities
Continued
• Full pre-admission work-up
• Prehabilitation where possible
• Early discharge planning
• Identify likely re-admitters (frailty score)
• Early medical contact post-op
• Phone contact for worried patients
• Review your litigation cases and learn from them
Local Issues
• Hubs, how many and where
• Combining teams
• Particular geographical problems
• Ensuring spokes are on board
• Shared pre-op work-up
• Accept post-op transfers
• Ensure links for referrals and MDT’s
• Regular reviews of data and outcomes
Questions
78
Mike Horrocks
GIRFT Vascular Clinical Lead
GIRFT Clinical Ambassador for South West Hub
E
M
Liz Lingard
North East, North Cumbria & Yorkshire Hub Director
M 07730374650
@seamlesssurgery #seamlessconnect18
Great care is discovered, not decided
Professor Tom Downes
Clinical Lead for Quality Improvement
Consultant Physician and Geriatrician
Sheffield Teaching Hospitals NHS FT
@seamlesssurgery #seamlessconnect18 Learning from failure
@seamlesssurgery #seamlessconnect18 Pyjamas
@seamlesssurgery #seamlessconnect18 20% reduction in LOS
@seamlesssurgery #seamlessconnect18 George
@seamlesssurgery #seamlessconnect18 Reduced hospitalisation of 40,000 bed days
@seamlesssurgery #seamlessconnect18 Sepsis
Proportion of all AAA procedures that are repaired by EVAR by
provider and provider type 01-Apr-2014 to 31-Mar-2015
64
Proportion of Aneurysms repaired by EVAR
65
Proportion of all unruptured (elective) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015
(x2 variation)
Proportion of all ruptured (emergency) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015 (x10 variation)
Proportion of patients readmitted in an emergency within 30 days
for any reason following an AAA procedure by provider and
provider type: initial admission 01-Apr-2012 to 31-Dec-2014
66
EVAR procedure Open procedure
In-hospital mortality following any AAA repair procedure by
provider and provider type 01-Jan-2015 to 31-Dec-2015
67
(x10 variation)
Proportion of patients receiving a CEA procedure of any type within 7 days of referral to a Vascular service by provider and provider type 01-Jan-2014 to 31-Dec-2014
(x6 variation)
Median days from assessment to surgery for CEA repair by provider and provider type 01-Jan-2014 to 31-Dec-2014
(5-30 days variation)
Proportions of post-surgical destination ward type post CEA
procedure by provider 01-Jan-2014 to 31-Dec-2014
70
Proportion of all AAA procedures that are repaired by EVAR by
provider and provider type 01-Apr-2014 to 31-Mar-2015
64
Proportion of Aneurysms repaired by EVAR
65
Proportion of all unruptured (elective) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015
(x2 variation)
Proportion of all ruptured (emergency) AAA procedures that are repaired by EVAR by provider and provider type 01-Apr-2014 to 31-Mar-2015 (x10 variation)
Proportion of patients readmitted in an emergency within 30 days
for any reason following an AAA procedure by provider and
provider type: initial admission 01-Apr-2012 to 31-Dec-2014
66
EVAR procedure Open procedure
In-hospital mortality following any AAA repair procedure by
provider and provider type 01-Jan-2015 to 31-Dec-2015
67
(x10 variation)
Proportion of patients receiving a CEA procedure of any type within 7 days of referral to a Vascular service by provider and provider type 01-Jan-2014 to 31-Dec-2014
(x6 variation)
Proportions of post-surgical destination ward type post CEA
procedure by provider 01-Jan-2014 to 31-Dec-2014
70
Adjusted in-hospital mortality or stroke rate of patients undergoing a CEA procedure during the inpatient spell of the procedure by provider and provider type 01-Jan-2014 to 31-Dec-2014
(x10 variation)
Adjusted in-hospital mortality or stroke rate of patients undergoing a CEA procedure during the inpatient spell of the procedure by provider and provider type 01-Jan-2014 to 31-Dec-2014
(x10 variation)
Activity counts of lower limb revascularisation procedures by procedure type, provider and provider type 01-Apr-2014 to 31-Mar-2015
Average length of stay for elective lower limb bypass procedures by provider and provider type 01-Apr-2014 to 31-Mar-2015
Diabetic Non-diabetic
Average length of stay for elective lower limb bypass procedures
by provider and provider type 01-Apr-2014 to 31-Mar-2015
74
- twice as long if admitted as an emergency
Non-diabetic Diabetic
Recommendations
• Engage of profession with management
• Fully develop the Network Structure (for Vascular)
• Develop as an Urgent Specialty with fast through flow
• Engage with Spoke hospitals, clinicians and managers
• Ensure all patients have same priorities
• Share pathways and timelines with other teams
• Adequate staffing and facilities
• Consider 7 day operating with cases fed into facilities
• Arrange angioplasties to reflect the urgency and facilities
Continued
• Full pre-admission work-up
• Prehabilitation where possible
• Early discharge planning
• Identify likely re-admitters (frailty score)
• Early medical contact post-op
• Phone contact for worried patients
• Review your litigation cases and learn from them
Local Issues
• Hubs, how many and where
• Combining teams
• Particular geographical problems
• Ensuring spokes are on board
• Shared pre-op work-up
• Accept post-op transfers
• Ensure links for referrals and MDT’s
• Regular reviews of data and outcomes
Questions
78
Mike Horrocks
GIRFT Vascular Clinical Lead
GIRFT Clinical Ambassador for South West Hub
E
M
Liz Lingard
North East, North Cumbria & Yorkshire Hub Director
M 07730374650
@seamlesssurgery #seamlessconnect18
Great care is discovered, not decided
Professor Tom Downes
Clinical Lead for Quality Improvement
Consultant Physician and Geriatrician
Sheffield Teaching Hospitals NHS FT
@seamlesssurgery #seamlessconnect18 Learning from failure
@seamlesssurgery #seamlessconnect18 Pyjamas
@seamlesssurgery #seamlessconnect18 20% reduction in LOS
@seamlesssurgery #seamlessconnect18 George
@seamlesssurgery #seamlessconnect18 Reduced hospitalisation of 40,000 bed days
@seamlesssurgery #seamlessconnect18 Sepsis
@seamlesssurgery #seamlessconnect18 Discovered by staff from within
@seamlesssurgery #seamlessconnect18 CPD Credits
• Seamless Surgery Connect has been approved by the Federation of the Royal Colleges of Physicians of the United Kingdom for 5 external CPD credits.
• Please contact Rachael Keegan [email protected] if you would like a certificate of attendance emailing to you.