THE LEEDS TEACHING HOSPITALS NHS TRUST - DOC 3 by Yf96MFM

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									                                                            Agenda Item 7.3.5




                                Trust Board
                                31 July 2008

Report of                          Ruth Holt
                                   Chief Nurse

Paper prepared by                  Catherine Riley
                                   Directorate Manager MSK

Subject/Title                      Progress Report – Reducing Cancelled
                                   Operations
Background papers                  None

Purpose of Paper                   This paper will provide The Board with a
                                   progress report on the programme of work to
                                   reduce the number of operations cancelled on
                                   day for non-clinical reasons
Action/Decision required           Note the contents

Link to:                           NHS Cancelled Operations Threshold as
                                   noted in the NHS Plan
 NHS strategies and policy

Link to:                           Links to Trust Objective of Making LTHT the
                                   Hospital of Choice
 Trust’s Strategic Direction
 Corporate objectives

Resource impact                    N/A

Consideration of legal issues      N/A

Acronyms and abbreviations         N/A.




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                                                           Agenda Item 7.3.5



      THE LEEDS TEACHING HOSPITALS NHS TRUST
            BOARD MEETING - 31 JULY 2008

                TRUST BOARD PAPER
       PROGRESS REPORT - REDUCING CANCELLED
                   OPERATIONS



1.   PURPOSE OF THE PAPER
     This paper will provide The Board with a progress report on the
     programme of work to reduce the number of operations cancelled on
     day for non-clinical reasons.

2.   BACKGROUND
     The NHS plan states that when a patient’s operation is cancelled by
     the hospital on the day of admission or later for non-clinical reasons,
     the hospital will have to offer another binding date to treat the patient
     within a maximum of 28 days or fund the patient’s treatment at the time
     and hospital of the patient’s choice.

     In 2007/08, Leeds Teaching Hospitals NHS Trust (LTHT) performed
     48,154 operations, of which 1,388 were last minute cancellations for
     non-clinical reasons. This represents 2.8% against a national threshold
     of 0.8%.

     Of the 1,388 last minute cancelled operations for non-clinical reasons,
     1,180 were successfully readmitted within 28 days, however, 208 were
     not readmitted within 28 days. This represents 9.9% against a national
     threshold of 5%.

     In April 2008 a project group was established to
      Reduce the number of patients being cancelled by the Trust for
         non-clinical reasons from 2.8% to 0.8% by 30.09.08. This level
         should be sustained thereafter.
      Improve the Trust performance against the target of rescheduling all
         patients cancelled within 28 days of cancellation. The Trust
         currently reschedules 90.1% of patients within 28 days. By 30.09.08
         the Trust will reschedule 95% of patients cancelled within 28 days,
         in line with the national threshold.
      Beyond September, the aim of the programme is to have a zero
         threshold with regard to the 28 day readmission target and aim
         towards zero tolerance of last minute cancelled operations.




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                                                           Agenda Item 7.3.5


      The group set an interim target to reduce the number of cancelled
      operations by 50% by 31st July 2008.

      This project is sponsored by Ruth Holt, Chief Nurse, and managed by
      Steve Jamieson, Divisional General Manager Specialist Surgery.


3.    PROGRESS AGAINST PLAN
      Data collected by the Trust identified 3 surgical specialties that faced
      the biggest challenge in the management of cancelled operations.
      Phase 1 will concentrate on these three specialties. HDU Bexley Wing
      has also been chosen for redesign work as early diagnosis work
      identifies theatre scheduling and HDU availability as a bottleneck. The
      project group will also review the provision and transfer of management
      information to facilitate the management of cancelled operations. The
      project group has set up five workstreams to reduce the 28 day
      breaches of cancellations. The workstreams are focused in:

          Neurosurgery
          Urology
          Plastic Surgery
          HDU
          Provision of information

      The focus of the work includes:
       Ring fencing beds for elective surgical admission
       Improving transfer of information between stages of the patient
         pathway
       Review of the current cancelled ops database, reports required by
         surgical specialties, guidance provided.
       Provision of training in the use of cancelled operations information.
       Provision of a performance management trajectory for individual
         specialties.

      Performance against target is shown as a trend since Q1 07/08:

              Last Min Non-Clinical Cancellations     Breaches of the 28 day
                                                      standard
07/08 Q1                    203                             38
07/08 Q2                    239                             25
07/08 Q3                    409                             48
07/08 Q4                    539                             101

08/09 Q1                    400                              97

In 08/09 the breaches of the 28 day standard can be broken down further to
April 39, May 48 and June 10. At the point of writing The Board Report there
was no validated information for July.




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                                                        Agenda Item 7.3.5




4.   RECOMMENDATION
     The Board are asked to
      note the work being undertaken to improve the Trust performance
        against the national cancelled operations thresholds
      note that performance against the thresholds will be reported each
        month within the Integrated Performance Report.


Catherine Riley
Directorate Manager MSK
24th July 2008




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