The Health Foundation’s Post

Are you or your loved ones waiting for an elective surgery operation in the UK? The NHS is amazing but it has struggled with an enormous waiting list after the pandemic. In June 2024, out of 7.6 million cases on the waiting list for consultant-led care, 1.2 million were for people waiting for admission to hospital for elective surgical treatment! A new evaluation by The Health Foundation finds that hospitals that set up a 'surgical hub' have done better with their waiting list than those who have not. "These specialised ‘hospitals within a hospital’ are dedicated to planned surgeries using ringfenced staff and resources. This effectively separates elective care into two pathways: a hub focusing on high-volume low-complexity (HVLC) cases, such as cataract removal, tonsillectomy or hip replacement, and the rest of theatre space freed up for more complex cases. " In general they "performed 51,086 more procedures (with an uncertainty ranging from 5,523 to 98,030) than expected between April 2021 and March 2022. As well as delivering more operations, we also found that patients stayed in the hospital for shorter periods suggesting that hubs could make elective care more efficient overall. " https://lnkd.in/eGrNw6zZ From BMJ https://lnkd.in/eBKc8QST

Must be the money? Ambulatory surgery has increasingly become the standard approach for the vast majority of many surgical specialities with many surgeons performing ever more complex surgeries with patients benefiting from a same day experience. Over 90% of my urologic surgeries result in patients going home the same day. That experience however is limited for medicaid patients due to poor reimbursement which leads to a lack of investment in ambulatory surgery centers within communities dominated by low income patients. Often plans and provider groups report not being able to find surgical centers willing to take their patients even if surgeons are willing to take the relatively low reimbursement rates for their services. In South LA, the impact is dramatic with >80-90% outmigration of patients seeking ambulatory surgical procedures outside SPA6 (a service planning area who's population is ~1M in South LA). More important than the convenience of same day surgical care, the lack of elective surgical capacity leads to patients obtaining access sensitive surgeries in the hospital often via admission through the emergency department. Would you prefer having a hernia repair and resting in the comfort of your home or waiting 10 hours in an ED to get surgery after a 3 day admission? In hospitals, like my own, already overwhelmed by urgent and emergent conditions, these preventable acute surgical procedures that could have been performed electively strain already limited resources and overwhelm an already stretched surgical workforce. Additionally, we've come to observe that outcomes from access sensitive surgical conditions are better when performed electively than acutely in the hospital. Low and delayed compensation are seemingly the driving force behind the lack of ambulatory surgery in South LA. Yet other factors such as the mismatch between the narrow networks of surgeons that often are misaligned with the facilities where actual surgeries can be performed complicate this issue. Said differently, plans and provider groups contract with surgeons who do not have access to the facilities the plans and provider groups contract with to perform surgery. This leaves patients ping ponging between surgeons who may be able to see them in clinic to diagnosis their condition but not able to operate on them. These structural impediments to accessing ambulatory surgery need to change. And they can. Plans and provider groups can work together to align credentialing and contracting processes to reduce administrative burden and redundancy. Reimbursement rates should be increased to cover cost of services in these settings. Surgeons should be encouraged to explore business relationships with surgery centers in our Medicaid dominated communities. And patients will need to be aided in coordinating their surgical care and navigating outpatient perioperative care. We need to and can do better.

Why is it so important to ensure the surgical pathway is as efficient as possible? 🏥 A recent article from the Clinical Services Journal explains that thousands of operations were cancelled this year, whilst waiting lists are still extensive. See below 👇 "NHS figures show that over 21,053 operations were cancelled at the last minute for non-clinical reasons in the three months to the end of March 2024. The figures also show the total waiting list for NHS consultant-led hospital treatment decreased by 916 to 7.54 million." https://bit.ly/3wDQcoM Avoiding delays and complications is always important, but with ever growing waitlists, budget cuts and external challenges, we need to consider ways we can minimise disruptions when surgery does occur. Choosing passive warming blankets from THERMARMOUR reduces the chances of a patient developing hypothermia before, during, or after surgery. Preventing perioperative hypothermia is key in surgical pathway efficiency. This saves time, money, and improves the overall patient experience. A patient who develops hypothermia perioperatively requires longer to recover, using more resources and spending longer in hospital. #hypothermia #perioperativehypothermia #surgery #waitinglists #surgicalpathway

Since 2018, Getting It Right First Time (GIRFT) has been working to support the establishment of elective hub sites to help reduce NHS waiting lists. So we’re delighted to report that new research from The Health Foundation has provided evidence that NHS surgical hubs increase treatment volumes and reduce the length of time patients spend in hospital, helping to speed up efforts to tackle waiting lists. GIRFT worked with The Health Foundation’s Improvement Analytics Unit (IAU) to support its independent evaluation of the impact of elective hubs on trust activity levels - the first systematic assessment of the impact of hubs on this scale. The research examined the impact of surgical hubs on the rate of operations carried out by NHS trusts, comparing those that had recently established a hub and those that had a hub before the pandemic, and found that: 🔷 In their first year, the 31 trusts in England with newly opened hubs undertook 21.9% more high volume low complexity elective surgery (such as hip replacements and cataract removals) than they would have done without a hub. This amounts to around 29,000 more procedures than expected at these trusts during this time.   🔷In the year following the last Covid lockdown, the 23 trusts which had established a hub pre-pandemic undertook 11.2% more elective surgery (of all kinds) than they would have done without a hub. This amounts to around 51,000 more procedures than expected at these trusts between April 2021 and March 2022. As well as higher treatment volumes, evidence was found of shorter stays in hospital, suggesting that hubs also have the potential to improve efficiency in elective care delivery. Read more – plus a blog from Prof Tim Briggs and Elena Bechberger - on our website: https://bit.ly/3XjSp1X The Royal College of Surgeons of England Royal College of Anaesthetists Stella Vig Nicola Kennedy Graham Lomax Jane Rooney

Timely report on the impact of surgical hubs

Elective hubs are key to being able to operate on more patients. When I first started working on elective hubs, they were explained to me alike an F1 pit stop. Imagine if you could do the same operations with the same team multiple times per week. You would be able to become a well-oiled machine and be able to operate on more patients in the same time. We have been supporting Getting It Right First Time (GIRFT) as well as several Trusts with the planning for hub sites and its exciting to see the new research from The Health Foundation providing evidence that indeed hubs increase treatment volumes and reduce length of stay. Specifically the report finds that the 31 trusts in England with newly opened hubs undertook 21.9% more high volume low complexity elective surgery (such as hip replacements and cataract removals) than they would have done without a hub. This amounts to around 29,000 more procedures than expected at these trusts during this time. Read more – plus a blog from Tim Briggs and Elena Bechberger https://bit.ly/3XjSp1X

🤔 💡 Can High Intensity Theater Lists Be the Answer to Canada's Surgery Wait Time Problems? News from across the Atlantic offers a glimmer of hope in the battle against surgical wait times. A London hospital, Guy's and St. Thomas', has had significant success with a program called High-Intensity Theatre (HIT) Lists. Here's how it works: ➡ Two operating rooms operate side by side. ➡ Patients are prepped for surgery while the previous surgery is being completed. This drastically reduces downtime between procedures, allowing a week's worth of surgeries to be completed in a single day. The results are promising. Guy's and St. Thomas' has reduced backlogs in several specialties. They've done: ✅ 21 gynecologic oncology procedures in a single morning (typically 6 in a full day). ✅ 12 knee replacements in one day (normally 3-4). ✅ A week's worth of prostate surgeries in one day. Canada faces a similar challenge of long wait times for surgery. The HIT model offers a potential solution, but there are issues to consider, such as adaptability, scalability, and resource allocation. So, can High Intensity Theater Lists be the answer to Canada's wait time problems? Let us know what you think! Read More about the new approach here: https://lnkd.in/eUzkmF6n #CanadianHealthCare #WaitTimes #Innovation #Collaboration

🚑 Insightful Study on Interhospital Transfers in Emergency General Surgery 🚑 A comprehensive study conducted by Cindy Y Teng, Billie S Davis, Matthew Rosengart, Kathleen M Carley, Jeremy Kahn sheds light on the patterns and factors associated with interhospital transfers among patients with emergency general surgery (EGS) conditions. Findings: Hospitals with higher resources and EGS volumes tend to receive more incoming transfers but aren't necessarily linked to better clinical outcomes. This raises important questions about how hospitals are selected for transfers and the potential for improving patient outcomes by optimizing these networks. 🔍 Dive deeper into the study to learn more about the dynamics of hospital transfer networks and their impact on patient care. Earn 1.0 #CME credit by engaging with this research. https://lnkd.in/dQKC_qAg #HealthcareManagement #EmergencyMedicine #HospitalNetwork #MedicalResearch

READY TO GO HOME? Accelerated surgical treatment pathways, also known as enhanced recovery after surgery (ERAS), have become a popular option for patients undergoing various surgical procedures. ERAS has many benefits for patients, perhaps most notably in physiological parameters, but research also suggests that many patients can feel ‘back on track’ faster the sooner they are back on their feet and performing daily tasks. However, there is also research that suggests that there can be challenges for patients associated with these rapid surgical programs; challenges that particularly revolve around the lack of opportunities to integrate the existential dimensions of being in a life situation where diseases, such as cancer, suddenly become the lens through which life and everyday life is seen and lived. It can be unpredictable how the individual person reacts and handles a life situation where illness strikes. Thus, there are individual needs that must be met in the individual patient if nursing and treatment are to support and benefit the individual patient; and this part of nursing and treatment MUST succeed, even in ERAS programs! For many patients, it is in many ways helpful to get home as soon as possible to their own environment with the physical and psychosocial support that can be provided 'at a distance', while other patients have been put in a particularly vulnerable situation in a fast-paced treatment program that requires that acceleration is not the goal in itself. Some patients simply need to stay in hospital for a little longer than the program might prescribe. Prolonged hospitalization seems obvious when it comes to physiological problems or complications, but what about when it comes to other aspects of living with illness? Is it then okay for the patient to stay an extra day or two in hospital?    In the Department of Cardiothoracic Surgery at Copenhagen University Hospital, Rigshospitalet, in Denmark, the nurses and doctors are in no doubt that the most important thing is the individual patient's unique situation and life circumstances. Patients who can go home quickly after lung cancer surgery with support from the department's nursing outpatient clinic, they do so, while patients whose existential, psychological, or social situation requires several days in hospital, they stay. The goal is not a simplistic desire to keep patients in hospital longer, but rather a wish to ensure that patients don't suffer unnecessarily or fall through the cracks between the system's and patients' lifeworld perspectives.   Read more about professional judgement, clinical reasoning, situated nursing and much more in the article. Malene Beck Rene Horsleben Petersen Pernille Orloff Donsel IMPACT - Research & Care Rigshospitalet #lungecancer #nursingcare #eras #lungsurgery