News
Active Management of Critical Care Demand in Major Elective Surgery
North Cheshire Hospitals NHS Trust
Andrew Higgs, Consultant in Anaesthesia and Intensive Care Medicine, Ellis Clarke, Matron, Rajiv Sanger, Consultant Orthopaedic Surgeon, Mark Tighe, Consultant Colorectal Surgeon (North Cheshire Hospitals NHS Trust).
Patients having planned major surgery (e.g. aortic aneurysm repair) need admission to a high-dependency unit (HDU) bed post-operatively.
The single most common reason such operations are cancelled nationally is because the HDU is fully occupied, due to emergency (unplanned) operations or planned operations performed by other departments. In 2005, more than 25 per cent of major operations at North Cheshire Hospitals NHS Trust were cancelled due to a lack of HDU beds.
The Active Management service enables surgeons to book beds one to three weeks in advance, and these requests are considered and prioritised at a weekly meeting. As an outcome of the new process, on any single day, fewer patients have their operations cancelled. Additionally, when multiple requests cannot be avoided, managers have advanced notice, so that they can make more short-term beds and staff available.
Using this approach, the cancellation rate for major elective surgery at the Trust has been reduced to 7.3 per cent. As a result more patients receive their operations on the day they expect, reducing their anxiety and logistical difficulties for relatives. The Active Management service also maximises the efficiency of the Trust by informing appropriate staffing levels and utilising surgery theatres to the full.