Sydney Children’s Hospital

Paediatric Emergency Surgery

Mission Statement

AIM

To reduce the number of patients having emergency surgery out of hours at Sydney Children’s Hospital Randwick by 35% within the next 6 months

Team members & role

Facilitator Verity Luckey –Clinical Director, Surgery and

Anaesthetics, SCH

Project team members

Matthew Crawford –Clinical Director, Surgery and Anaesthetics, SCH

Susan Adams -Head of Department, Surgery, SCH

Fionnuala Torrisi –Nurse Manager, Waitlist, SCH

David Scott –Data Analyst, Clinical Effectiveness Support, SCH

Phyllis Davis –Nurse Manager, Operating Theatre, POWH

The Problem

Shared operating theatre suite with Randwick hospitals campus

Paediatric emergency surgery –approximately 50% of paediatric surgical case load

–relatively stable, particularly when compared to elective activity

SCH emergency theatre only a half day pm session –often delays in start time due to over runs of the am elective sessions (both adults & paediatrics)

Current elective surgical KPI’s set by the MoH (000)

Resulting Issues

• Wasted time for surgeons and nurses waiting for theatre start time

• Surgeon call backs afterhours due to delays

and lack of available theatre time • Resulting in acute surgical patients returning to

wards afterhours –less support /clinical staff

Flow Chart of Process

Complexity

PLAN DIAGNOSIS

As a multidisciplinary group we

Brainstormed the causes of out of hours surgery

Used Post-its (one idea/post-it) and on butcher paper to capture the positive processes and the challenges

• Group discussion and agreement on the themes identified

Found consensus on key themes

Collected Data

Group agreed to a follow up meeting focussed on ‘finding solutions’

PLAN DIAGNOSIS

Top 5 issues around having a dedicated all day paediatric emergency theatre session:

Patient Safety

Theatre Session Availability

Surgeon Availability

Anaesthetic Availability

Patient and Staff Experience

Cause and effect diagram

SCH Emergency Surgery Cases 2010

General Surgery -34% of emergency activity to emergency theatre

Plastics -21% of emergency activity to emergency theatre

Orthopaedics-20% of emergency activity to emergency theatre

SCH Emergency Surgery Cases

Evidence for Change

Interventions

Dedicated Monday to Friday paediatric emergency list

General surgeon nominated for daily emergency surgery theatre session

Identified need for Paediatric Anaesthetic Day Coordinator

Customer and expectations list

With the introduction of a Monday to Friday all day paediatric emergency theatre list

Intervention - plan

Important Ministry for Health (then DoH) was running a

pilot for hospitals in NSW to introduce Emergency Surgery.

SCH had commenced this project and sent our data to apply for the pilot however we were unsuccessful.

We continued on with the project and met with the MoH Emergency Surgery Project Team once we had introduced the all day Monday to Friday paediatric emergency Sessions.

• Following these further meetings and discussions, representing the progression of our project, we were successful in being added to the end of the MoH Emergency Surgery project.

• Result –Consultation and advice from Price Water

House Coopers and MoH

• Surgical redesign school • Recurrent funding for Emergency Surgery at SCH.

Important

Impact of Implementation

Impact of Implementation Paediatric Emergency Surgery was commenced in

March.

The Afterhours emergency surgery drop was immediate and significant. Reduction 15% to 8% out of hours.

Results of change in practice

Improved patient care Reduced fasting time

Reduction in delays

Reduction in elective surgical patient cancellations

Family satisfaction with hospital Confidence in hospital

Hospital Benefits Decreased bed block

Reduced overnight stay for emergency patients

Staff satisfaction

Challenges

• Staff shortages • Preference for using certain theatre room • Theatre roster redesigned to accommodate

staffing requirements

Strategies for Sustaining Improvement

Continue to monitor, collect and report data

Continue to collaborate closely with surgeons, anaesthetists and theatre staff

Regular agenda item on the Operating Theatre Management Committee (OTMC)

Planned audits

What next

Appointment of emergency /acute care surgeon

NEAT

NEST