Tanya Montgomery - Wollongong Hospital - Pod Teams in Operating Theatres to Improve the Delivery of...
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Transcript of Tanya Montgomery - Wollongong Hospital - Pod Teams in Operating Theatres to Improve the Delivery of...
TWH Urology ‘Pod’
Tanya Montgomery (Fraser)
Clinical Nurse Specialist
Wollongong Hospital
Outline for this Presentation l Brief history of Urology Services at Wollongong
Hospital.
l Data / numbers to assess change
l What are Pods ?
– How do they work in Urology surgery ?
– How have they improved the Urology team efficiency.
l Our journey and reflection.
Illawarra Shoalhaven Local Health District
l 250km coastline
l 390,000 people
l 9 hospitals
l Wollongong = major referral & teaching hospital
(islhd.health.nsw.gov.au/about_us)
Wollongong Hospital l 500 + beds
l 12,500 surgical cases each year
l 15 Theatres (10 commissioned)
l 12 Specialties
l 500 + beds
l 12,500 surgical cases each year
l 15 Theatres (10 commissioned)
l 12 Specialties
What changed in 2015 ? l IESS 7 New Theatres built and 5 are currently
commissioned for service July 2015
l 2 Hybrid Theatres (x-ray, control room, tegris)
ð designated urology theatre (OT14)
ð designated urology sterile stock room joining theatre
Sterile stock room Control room
What changed in 2015 cont’d l Reclaimed cases from Private
Urology Activity Increased ! l 1250/yr additional cases back from Private
l At least 3 additional urology lists / wk
l Doubled instrumentation
Urology Cases June 2015 vs. June 2016
Month/Year OperationsJune 2015 96
Elective 59Emergency 37June 2016 188
Elective 159Emergency 29
What changed in 2015 cont’d l Urology Theatre:
Ø 7 Urologists
Ø Urology cases 5 days / week
Ø 188 Urology cases each month (3-14/day)
Ø Storz à Olympus
Ø Introduction of laser
Greenlight Laser
g
Holmium Laser
Introduced ‘Pod’ concept 2015
Introduced Urology ‘Pod’ 2015 l ‘Pod’ = Small team
ü Improved attitudes, behaviours, communication & accountability
ü Improved workflow collaboration
ü Conserve valuable time / increased efficiency
l Formed Urology Pod ð Urology CNS
ð Communication
ð Resource Folder
Who is who in the Urology Zoo
l Specialised structured / Urology CNS & Nurses
l Stand alone theatre ü Organise own lists ü Direct contact with D/O ü X-ray on call ü Designated OTA
Inside our Urology ‘Pod’ Who is who in the Urology Zoo (cont’d)
l Team ownership
– Less sick leave
– Excellent staff retention
l Surgeons get experienced nurses J
– Core group and new learners
Clinical Nurse Specialist l Full time
l 1 non-clinical day a fortnight !!
l Elective Surgical Liaison Nurse (Jane)
l Resource folder / team education
l Preference cards
l Clinical Products (loan/new instrumentation)
l Standing orders save time – Overnight delivery, no approval process
l Liaise with CSSD
l Communicate with stakeholders
l In conjunction with surgeon configure daily lists
FIRST CASE ON TIME - UROLOGY MARCH 2015
SESSION NAME
TOTAL ELECTIVE SESSIONS
FIRST CASE ON TIME SESSIONS
FIRST CASE ON TIME SESSIONS
%
Doctor D 3 2 67%
Doctor C 2 1 50%
Doctor B 2 1 50%
Doctor A 4 0 0%
TOTAL 11 4 36%
FIRST CASE ON TIME - UROLOGY MARCH 2016
SESSION NAME
TOTAL ELECTIVE SESSIONS
FIRST CASE ON TIME SESSIONS
FIRST CASE ON TIME SESSIONS
%
Doctor A 3 3 100%
Doctor B 4 3 75%
Doctor C 3 2 67%
Doctor X 4 2 50%
Doctor D 5 3 60%
TOTAL 19 13 68%
Before
After
Turn around times
l TWH urology average turn around times
June 2015 = 19.5 mins
June 2016 = 10.5 mins
ð improved TA time by 9mins !!!!!
Theatre Utilisation
Year
CasesSlot
duration
In room
Utilisation
June ‘15
58
6900 min
4692 min
68%
June ’16
144
11430 min
9900 min
87%
Before and after ‘Pod’ Before
l Urology 3 days/wk
l No Urology CNS
l Allocated different nurses
l Check cystoscopies = Rigid cystoscopies Day Stay
l Lots of TURPs
l Longer LOS
After l Regained all public patients
l Urology 5 days/wk with POD team
l Urology CNS with dedicated non-clinical time
l Hybrid theatre / designated x-ray
l Set & run own lists
l Team huddle
l Green light & holmium laser
l More flexi cystoscopies under local bypass PACU
Team bonding à Improved Efficiency
Upon Reflection l Too many new aspects introduced simultaneously
l Education / Preparation time
l Designated roles prior to commencement
l ‘Pod’ member Laser safety officer trained
l Instrumentation
