The Surgical and Anaesthesia clinical team visited Bedford Hospital NHS Trust on 15th November. After a warm welcome and some breakfast, we started off with a discussion on the approach they had taken to implement the Five Steps to Safer Surgery.
The Safer Surgery Checklist was implemented as a pilot in July 2009 followed by full implementation in November 2009 after some local adaptation. An audit done in February 2010 showed that it was being used 95% of the time for surgical procedures and the initiative had been driven locally by theatre teams. Early results have shown an improvement with patient safety, especially with local issues such as pathology specimen labelling and traceability of blood products.
We all got a chance to see the surgical checklist ‘in action’. A couple of us were taken to the general surgical theatres where we witnessed the “time out” and “sign out” part of the surgical checklist on a laparoscopic cholecystectomy and shoulder arthroscopic procedure. Two of us went to the maternity unit to witness the maternity checklist being used for C-section procedures. It was very positive to see that staff were using the Checklist conscientiously and that it was embedded into routine practice
Currently, the checklist is part of routine practice in most planned surgical operations; Staff at Bedford are now also in the process of introducing team brief for all lists, and the checklist has also been adapted for usage in the Ophthalmology and Obstetrics specialties.
We also heard about the progress they were making with implementing The Productive Operating Theatre. In order to encourage more staff involvement and keep staff up to date, the hospital has a staff board displaying information such as the number of patients operated on, the percentage of lists starting on time and the number of incidents reported. These are collected on a monthly basis, providing the ability to demonstrate improvement over time. There is also information on staff birthdays – and a surprising number of operating theatre staff are having a 21st birthday!
On another note, the hospital had recently won a public nominated award for the cleanest hospital in the UK, beating competition from a group of 400 hospitals in the UK. The Trust had also recently had a patient safety week during which their work was being promoted to patients and the public.
For the future, the Trust plans to ensure that the Five Steps becomes integrated into practice for all surgical procedures, and persuade staff that patient safety and productivity are not mutually exclusive. The ultimate aim is to improve patient outcomes, reduce harm and maximize productivity.