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Theatre nurses encouraged to improve productivity

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A programme that empowers theatre nurses and other surgical staff to make changes to their daily operating regimen can improve both staff satisfaction and service quality, pilot results suggest.

The Productive Operating Theatre programme, launched last week in London by the NHS Institute for Innovation and Improvement, is the latest in the series of programmes that started in January 2008 with the Productive Ward.

The initiative encourages frontline staff to identify problems with their operating procedures – both technical and behavioural – and find ways of solving them, based on evidence from six pilot sites.

Speaking at the launch, NHS Institute lead associate Amanda Fegan said the pilots had shown it improved patient safety, staff job satisfaction and efficiency.

For example, there had been an average 25 minute reduction in daily start times and a 63 per cent reduction in average patient turn-around times.

There had also been overall reductions in patient pain scores during recovery and an increase in the percentage of patients with an axillary temperature on arrival in recovery above 35.4 degrees, from 95 per cent to 98 per cent.

Heart of England Foundation Trust lead nurse for theatres and day surgery Ann Abbassi has piloted the programme since last September.

She told Nursing Times that a patient feedback questionnaire and an annual staff attitude survey had been introduced to identify areas for improvement and measure progress. Additionally an “off-site” meeting, involving all members of the surgical team, had been used to discuss the current operating procedure.

Among the top frustrations was the over-running of lists, which meant staff routinely had to work late, and delayed start times in the morning, usually caused by the “chaos of not being able to find equipment”.

The resultant improvements included better storage and labelling of equipment, and a clock being placed in the theatre that patients could look at.

The intervention with the “quickest impact” had been the introduction of briefings and debriefings on the day’s patients at the start and end of the day, said Ms Abbassi.

The briefings, borrowed from the aviation industry, allowed the entire surgical team to hold an open discussion twice a day.

She said: “The briefing at the beginning sets the scene – the team discuss all the day’s patients before they are called down. The debriefing at the end of the list allows the team to discuss what went well, what can we celebrate and what can we do better.”

The pilot had led to improved start times, reduced overruns, reduced delays between cases and staff were happier, she said.

“The programme’s not about cuts, it’s about getting control of the environment and working more effectively. It’s a win, win situation from the staff point of view,” Ms Abbassi said. 

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