SCTS BOR Ed meeting September 2017 Blackpool presentation

SCTS BOR (Ed!) meeting September 2017 Blackpool presentation Joseph Zacharias

Success has many fathers… The team at Blackpool 1: Same day admissions. 2: VATS lobectomy. 3: Finance and coding.

Initiative in 2010 Cardiac Liaison Ns Anaesthetists Surgeons 60% of all eligible patients May 2011 Oct 2010 Dec 2015 Jan 2010 Nurse Practitioner 20% of all eligible patients Dec 2010 75% (63/ 84) patients as SDA Nov 2011 “Every great journey starts with a small step” Same Day Admissions or Day of Surgery Admission (DOSA) Timeline

Same day admissions ❖ ❖ ❖ Patients are listed for surgery. Patients are seen by anaesthetist at a pre admission clinic and all blood tests done about 4 to 10 days before op date. Results are reviewed by a nurse and abnormal tests highlighted to surgeon and anaesthetist If all okay patient is phoned and told to come at 0730 in the morning At present 80% of our elective patients are admitted on the morning of surgery

Same day admissions Advantages : ❖ Patients love it ❖ Frees up beds ❖ ❖ ❖ Reduces cancellations Possible cost savings! Reduce overall length of stay 100 95 Percentage ❖ Patient Satisfaction Happy for SDA Arrival time Anaesthetist at PAC Overall Experience Recommend 90 85 80 Cycle 1 Cycle 2 Cycle 3

Same Day admissions ❖ Disadvantages: ❖ More work for secretaries ❖ Needs a space for early morning admissions ❖ Beds freed up end up used by other specialities! ❖ Patient makes one extra trip to the hospital

Is SDA safe? ❖ ❖ All patients who underwent cardiac surgery between June 2013 May 2014 Total number of patients- 1210 – SDA- 476 – Non SDA – 734 – Differences in outcomes – Duration of ventilation, Postop stay, blood transfusion, MOF, Mortality – Further Analysis – SDA first patient on list Vs SDA Others • First on list 232, Not first on list 244 – Matched Data Patients who underwent surgery as SDA did not have worse outcomes There was no difference in outcomes between patients who were first on list and not first on list

Pneumonectomy Lobectomy Wedge Total 203 179 139 118 129 95 105 144 109 108 144 76 18 13 23 11 24 5 2010 2011 2012 127 70 33 6 26 10 28 7 6 2013 2014 2015 2016 “Good artists copy, great artists steal” Picasso. VATS lobectomy Thoracic surgery team

Thoracic surgery by Cardio-thoracic surgeons! ❖ First step was to send interested surgeons to a lung cancer MDT ❖ Difficult cases are discussed at a second opinion MDT ❖ VATS lobectomy was offered but sporadically until 2015 ❖ Bristol Thoracic surgeons were visited to inspire us. ❖ ❖ ❖ Thoracic surgeon was funded in 2015 to spend 6 weeks in Copenhagen to bring back ideas 80% of all lobectomies are done by VATS for early stage cancer. Enhanced recovery with increased input from physiotherapy is expected to reduce length of stay.

Blackpool Lobectomy split 160 144 127 109 120 108 85 74 80 68 27 40 6 7 2013 2014 0 2015 VATS Total 2016 Aug-17

Smoke and mirrors Finance and Coding Lack of transparency. What is an operation worth? When do we make money and when do we lose money? Coding every procedure and capturing case complexity. As a national body we need to be mindful that expensive percutaneous options are coming through.