CEPOD—collaborative effort for patient outcome development

Abstract

Background: Operating theatres available 24 h a day for emergency surgery (CEPOD theatres) were introduced in the early 1990s after recommendations of a Confidential Enquiries into Perioperative Deaths (CEPOD).1 However, their efficiency remains a challenge. Multiple interdependent factors interact for a patient to be operated on in a timely and safe way. This project attempted to identify inefficiencies in the process of getting an emergency patient to theatre and introduced improvements to the system to optimise use of theatre time. Methods: Over a 1-month period, we collected data on 95 patients who were operated on in the CEPOD theatre. Data collection was done between 0800 and 1800 every day, including weekends. The information collected included time of booking, time of surgery, CEPOD category, and length and reason for delay if applicable. The steps in preparation that were considered were preparation by the surgeon, anaesthetist and the ward, team briefing, sending and arrival to the CEPOD theatre. Results: There were missing data for three patients, with data for the remaining 92 analysed. In most of the cases (61%), a delay in one or more steps in the preparation was identified. Half of the bookings belonged to the urgent category (total 46) that required surgery within 2–6 h, but in 56% of these the target was not met. The median waiting time for immediate surgery was 1 h, for urgent surgery was 7 h and 7 min, and for an expedited surgery was 15 h. When analysing the cases with delays individually, there was a clear pattern in which one delay led to delays in the subsequent steps. Conclusion: There are many steps that could be taken to streamline the patient flow and reduce delays, with the potential to improve patient outcomes. We presented the data at clinical governance meetings of all surgical subspecialties and collated feedback on improving efficiency and engagement. The action plan included an 8 am CEPOD theatre ‘huddle’ where surgical specialties discuss their listed patients and agree a list order, a transparent and remotely accessible electronic booking system, a ‘golden’ patient prepared the previous day to be first on the list, a checklist to ensure each patient is adequately prepared, appointment of leads from surgical and anaesthetic teams to drive progress, and better engagement through taking collaborative decisions. A re-audit is in progress. 1.Buck N, Devlin HB, Lunn JN. The report of a confidential enquiry into perioperative deaths. London: Nuffield Provincial Hospitals Trust/King's Fund Publishing Office 1987. Available from https://www.nuffieldtrust.org.uk/files/2017-01/confidential-enquiry-into-perioperative-death-web-final.pdf (accessed 20/03/23)