Children's Walk In-Walk Out operating theatres at Royal Manchester Children’s Hospital

The context

This initiative commenced August 2020 after the first wave of Covid to help restore paediatric surgical activity. Covid accelerated work on this that had been postulated pre-Covid as part of our established Theatre Improvement MDT group.

MDT mapping of the theatre journey for children who did not require an inpatient stay to look at points where we could make a positive change using limited established resources. 

Readdressed our beliefs/behaviours in terms of patients and families having autonomy for self care. Using this model we have received positive feedback from patients and families. 

Initiative Overview

·        MDT collaboration and engagement: clinical and non clinical teams

·        Operating for 12 months: 1200 patients through, ENT, dental, paeds surgery, orthopaedics, plastics.

·        A ‘walk in, walk out’ model of theatre flow for daycare surgery was developed as part of RMCH’s Covid recovery programme.

·        The patient flow occurs entirely within the theatre complex

·        The reception/waiting area, which was previously under-utilised, is used for admissions

·        The WIWO lead nurse lead attends scheduling meetings to identify those suitable patients 4 weeks ahead

·        Children all have a pre-op telephone assessment

·        A 2 stage recovery process is used with nurse led discharge using physiological parameters

·        There is an aim to invest so this can run 7 days a week

·        We are sharing this within the region as a model of care

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The impact

·        Enhanced patient experience, especially for frequent attenders

·        The admission process, which has been significantly streamlined

·        The length of stay for many procedures, such as adenotonsillectomy, has been reduced. 

·        Earlier theatre start tines are now possible. Releases day case capacity. Positive impact on emergency List.

·        The decreased turn around time, closer proximity to theatre and close team working has lead to the ability to run high volume, rapid turnaround lists with dramatic increases in productivity and efficiency.

·        Reduced reliance on hospital day case or inpatient beds.  This reduces the chance of cancellations due to bed pressures.

·        In using this facility for children who require urgent, non-scheduled surgery but are fit to be at home, such a minor plastics emergencies, we are able to significantly reduce waiting times for these children resulting in a reduction in inpatient bed usage and improvement in patient experience.

·        Reduces waiting times for non scheduled urgent surgery from emergency list.

·        The use of WIWO has complimented our refinement and improvement of our ‘adenotonsillectomy for OSAS’ pathway which has resulted in a reduction in LOS, increased day care rates, reduced readmissions and improved patient experience.  This is something which we are intending to disseminate across Greater Manchester

Key Learnings

What specific factors supported or hindered progress?

Engagement and collaboration massive support. Hindered by not having WIWO as a selected ward on the system to pre-admit to in outpatients and on the PAS system.

What would you change about the initiative in hindsight?

Start collecting all data from the start, set up WIWO as a “ ward space” on computer systems. Advertise and educate all surgical specialties of its existence and logistics

What advice would you impart to other systems?

Do it!