The BMJ Awards 2019: Anaesthesia and Perioperative Medicine Team of the Year

Reducing cancellations

Having an operation cancelled on the day is annoying and inconvenient for the patient and means that theatre time is not fully used.

Rebecca Barker, consultant anaesthetist and pre-op lead at Sherwood Forest Hospitals, analysed emails detailing on-the-day cancellations and thought they could do better. “There were some common problems that we thought could be avoided—if patients had been unwell for a few days before the operation, for example, or if they had forgotten to stop taking their warfarin,” she says.

The team remedied this by calling every patient five days before their scheduled operation to ask about their general health, check if they still needed the operation, and remind them of starvation and drug instructions. If a patient’s operation had to be cancelled for any reason, then there was still time for the theatre slot to be backfilled from the waiting list.

As a result of the project, the on-the-day cancellation rate went down and session use in theatres rose from an average of 85% to 90%, leading to a projected saving of £250 000 (€291 000; $331 000) over a year.

“Another advantage of the project was being able to identify near misses—if swabs had not been done, for example, or if something was missing on the paperwork,” Barker says.

Perioperative pharmacy team

Patients undergoing elective surgery often have existing comorbidities and are taking a number of drugs. The prescribing of routine drugs is often performed out of hours by on-call teams when the patient arrives on the ward post-surgery.

Wirral University Teaching NHS Hospitals Trust set up a dedicated pharmacy prescribing …