Curtain up on theatre systems

Running a theatre suite more efficiently can deliver big time, cash, and quality benefits to a hospital. That puts the onus on IT, says Jennifer Trueland.

As a cardiac surgeon, Ben Bridgewater felt at first hand the frustrations of problems in the operating theatre. So perhaps that’s why he is now spending his time trying to make sure that the only thing on the surgical team’s mind is doing the job that they’re there to do.

“It’s wrong to look at the theatre in isolation, because the whole system is involved,” he says. “As a consultant, I’d get in at 8am with the aim of seeing the patient and starting at 8.30am.

“But sometimes the theatre hadn’t sent for the patient, or there were no ITU beds, or no beds on the ward. We might be waiting for 45 minutes then find that some of the equipment was missing. So instead of being a cardiac surgeon, I’d be a bed manager, or a syringe driver finder.

“Theatre productivity is connected to the wider system – to patient flow and asset tracking and everything else. And we can’t forget that.”

Using IT to let teams do the job on hand

This is a message that vendors in the theatre management space are trying to get across. They point out that that digital solutions, properly deployed, can smooth the whole process, benefiting patients, NHS finances, and, of course, enabling the clinical team to get on with the task in hand.

It’s something that Bridgewater – who is now working with healthcare IT giant CSC, a company that has the lion’s share of the theatre management market in the NHS (according to Digital Health Intelligence data) – feels very strongly about.

He left the NHS at the height of his career to join CSC because he saw the value in a digital present and digital future, and wanted to help drive that. Having led the national programme to publish activity and mortality for 5,000 surgeons across a number of specialties, he is also a big believer in transparency.

“IT can help with different things, such as getting smarter about scheduling stuff, smarter about bed management, and clever analytics,” he says. “But I think the NHS is still playing catch-up with logistics, and can learn from other sectors and companies about how it can do things better.”

Improving quality and efficiency in the operating theatre has periodically been the subject of high profile initiatives in the various national health services across the UK over the past decade.

For example, the now defunct NHS Institute for Innovation and Improvement introduced the productive operating theatre programme in 2009, with the aim of improving quality, safety, efficiency and outcomes – as well as saving the average trust £1.7 million per year.

The NHS Institute might be no more, but it would be fair to say that there is still work to be done to improve theatre quality and efficiency. Even some trusts that were among the earlier adopters in terms of digital theatres are still relying on paper, with its concomitant risks both to efficiency and safety (such as poor handwriting leading to mistakes).

As the digital theatre markets mature, however, and as the pressure for efficiency savings becomes ever more acute, trusts that are taking the plunge and investing in fit-for-purpose systems are noticing the benefits.

Using the EPR supplier (SurgiNet in Bath)

Royal United Hospitals Bath NHS Foundation Trust has been using Cerner’s theatre management solution, SurgiNet, since August 2011.

“We did have an electronic theatre system before, but it was standalone,” explains EPR and IT service and operations manager Rachel Linegar. “Having an integrated system has enabled us to make theatre information available to all staff with appropriate access to the patient’s records.

“The surgeons request the surgery electronically, and the whole process is managed within Millennium [Cerner’s healthcare information system].”

The system has improved the efficiency of the operating theatres to give patients a better service. “For example, theatre staff attempt to complete the surgical record in real-time where possible, so day case discharge summaries can be completed as the patient leaves theatre.

“Theatres have ambitions to go completely paperless, and we are supporting them with this, but it wouldn’t have been possible without SurgiNet.”

Going to a specialist (Bluespier at Sherwood Forest)

While some trusts are opting to use their electronic patient record supplier’s system, or a module of it, in their theatres, others are turning to specialists.

Sherwood Forest Hospitals NHS Foundation Trust has just deployed Bluespier’s theatre management system to manage the clinical and administrative functions of its theatres, including scheduling, patient tracking and operations notes and coding (this last being a vital part of a TMS because it helps to make sure that trusts get paid).

Remarkably, the deployment was achieved in just 12 weeks. According to Martin Tooth, who is the project and business change manager of Nottinghamshire Health Informatics Service, which managed the roll-out, the tight timescale focused minds.

“The trust is due to merge with Nottingham University Hospitals NHS Trust, which was already using Bluespier,” he says. “It made sense to use the same system, and the deployment went very well.”

He anticipates that the new system will bring benefits. “I think the trust will realise time savings and also efficiency savings,” he says. “There’s been excellent engagement from clinical staff, which has also been an important factor, and there’s a recognition that this is good for the trust and for patients as a whole.”

Integrated systems are key

Alex Chen, who leads on Cerner’s theatre solution SurgiNet, agrees that interoperability, and being part of the bigger picture is key.

Like CSC’s Bridgewater, the former theatre IT manager knows only too well the challenges facing theatres, and their interdependence with what’s going on elsewhere in the system.

“Theatre departments are very focused on theatre efficiency, but sometimes there are things they can’t control, like bed pressures, or patients cancelling at the last moment. It’s hard to bring patients in [to fill gaps] if they’ve not been through all the necessary pre-operative tests.

“But if you have an integrated system to improve processes – for example, having a list of patients who have already been assessed and are ready for surgery, and have given all the necessary consents – then you can use your theatres more efficiently.”

Trusts can also use data generated from actual performance of their surgical teams to schedule appointments accurately, he adds. “If you schedule appointments based on the actual length of procedures, you improve efficiency,” he says.

Seeing the whole show

While Chen also accepts that looking at the whole system is vital, he is clear that it works both ways – with optimal theatre management being an important part of whole-system flow.

“Theatres are a hugely expensive resource, and cost thousands of pounds a day even when you’re running them empty,” he says. “It makes sense to make as best use of them as you can.”