British Hospital Blasts Through Waiting Lists By Slashing Surgeon Downtime [Hackaday]

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It feels like it doesn’t matter where you go, health systems are struggling. In the US, just about any procedure is super expensive. In the UK and Australia, waiting lists extend far into the future and patients are left sitting in ambulances as hospitals lack capacity. In France, staff shortages rage furiously, frustrating operations.

It might seem like hope is fruitless and there is little that can be done. But amidst this horrid backdrop, one London hospital is finding some serious gains with some neat optimizations to the way it handles surgery, as The Times reports.

Keep ‘Em Moving

The new innovative model is the brainchild of Imram Ahmad and Kariem El-Boghdadly, a pair of consultant anesthetists working at Guy’s and St Thomas’ NHS Foundation Trust. The latter compares the surgery setup to the way motorsport pit crews slash the time of a pit stop, by effectively splitting up tasks and designating their completion to certain individuals. For example, a Formula 1 team doesn’t change one tire at a time. Instead, 12 crew members change four tires at once—usually in less than 3 seconds.

The duo’s trick to speeding up surgery is similarly down to parallelizing operations. It involves setting up two operating theatres side by side. While surgeons are operating on one patient, another is being prepped in the second theatre.

When they complete one procedure, they can move straight to the next procedure with the patient already under anaesthetic and ready to go into surgery. “The anaesthetic happens while another patient is being operated on, and as soon as patient number one is done and leaves the operating room, the second patient has come in the operating room already anaesthetised,” El-Boghdadly told The Times. 

Cleaning is optimized too, with nurses able to clean a theatre post-procedure in under two minute, ready for the next patient to roll in. The operating method is called “High Intensity Theatre”, or HIT for short, and typically runs on weekends at Guy’s and St Thomas’.

The results have been astonishing, helping clear long waiting lists in record time. One Saturday at St Thomas’ hospital saw a third of gynaecological oncology list cleared in a single morning. Where the team would usually do 6 operations in a full workday, they were able to clear 21 cancer diagnostic operations by lunchtime. HIT methods were also used to complete three months worth of breast cancer operations in just five days during one stretch in August, while a prostatectomy team were able to achieve a week’s worth of operations in just one day using the method.

El-Boghdadly is keen to note that it’s not about rushing surgery or cutting corners, but finding efficiencies. He notes that the hospital routinely knocks off two to three times as many surgeries in a day than when using more routine operational procedures.

Working more efficiently has knock-on health benefits too. Many diseases, like cancers, benefit from early detection. Getting patients in for surgery sooner could thus improve outcomes versus those who get stuck on waiting lists for weeks or months for a simple diagnostic.

Indeed, it’s not unlike the optimization that a manufacturing engineer might do to a production line. In a factory, there’s little value having workers around waiting for parts to assemble, for example. In much the same way, it’s silly to have high-dollar, highly trained surgeons twiddling their thumbs while they wait for patients to be prepped for their next surgery. Anything that keeps them working more and reduces their downtime can be a good efficiency gain.

Obviously, it’s still important for staff to take breaks to rest and the like, but the elimination of dead times and the dreaded “hurry up and wait” can be a huge boon. Why spend millions upon millions building more theatres and training more surgeons? If the HIT method really does work, then simply reallocating some staff resources can get many more surgeries out of existing staff in the same amount of time. Spread that across a whole hospital system, and the benefits would be huge.

With waiting lists in many countries stretching out to the moon, this methodology could be a long-overdue way to help get them back down, to the benefit of patients and administrators alike. Here’s hoping the HIT method can bring these benefits to more hospitals around the world.