Getting going on time: reducing neurophysiology set-up times in order to contribute to improving surgery start and finish times

At the Walton Centre we conduct a relatively large number of complex and lengthy elective (booked) spinal operations. Recently, we have had a particular problem with half or more of these sessions finishing late, resulting in staff discontent and greater use of on-call staff. These operations require patient monitoring by neurophysiology clinical scientists. Before the surgeon can start the operation, in-theatre neurophysiological measurements are required to establish a baseline. We reasoned that reducing this set-up time would reduce the risk of surgery starting late, and so the whole session finishing later than expected. In this project we redesigned the neurophysiology parts of in-theatre patient preparation. We conducted five Plan-Do-Study-Act cycles over 3 months, reducing the duration of pre-surgery preparation from a mean of 70 min to around 50 min. We saw improvements in surgical start times and session finish times (both earlier by roughly comparable amounts). The ultimately impact is that we saw on-time session finishes improve from around 50% to 100%. Following this project, we have managed to sustain the changes and the improved performance. The most impactful change was to conduct in-theatre neurophysiology patient preparation simultaneously with anaesthesia, rather than waiting for this to finish; when we performed this with a pair of clinical scientists, we were able to complete neurophysiology patient preparation by the time the anaesthetist was finished, therefore not introducing delays to the start of surgery. A final change was to remove a superfluous preparatory patient-baseline measurement. This is a very challenging and complex environment, with powerful stakeholders and many factors and unpredictable events affecting sessions. Nevertheless, we have shown that we can make improvements within our span of influence that improve the wider process. While using pairs of staff requires greater resource, we found the benefit to be worthwhile.