Theatre Efficiency Research Articles

The Importance of Surgical Cutting Time as a Key Performance Indicator Alongside Touchtime Utilisation in Operating Theatre Efficiency Optimisation.

Aims The Getting It Right First Time(GIRFT) programme has set targets to achieve 85% touchtime utilisation by 2024/25. Touchtime utilisation is a measure of theatre productivity, defined as the time from the start of anaesthesia to the time a patient leaves the theatre for all cases on a defined theatre list as a percentage of total available theatre time. No published evidence examines touchtime utilisation as a measure of theatre efficiency and its correlation with surgical cutting time. This study aims to determine if there is a statistical relationship between touchtime utilisation and surgical cutting time, and whether the use of touchtime utilisation is sufficient to inform about surgical productivity. Methods A retrospective analysis of two orthopaedic theatres spanning 100 days at both a major trauma centre and an elective hospital in London was performed. Electronicrecords identifiedanaesthetic start time, knife-to-skin time, end-of-procedure time, and patient-leaving-theatre time. Time intervals were calculated and the relationship between touchtime utilisation and surgical cutting time was assessed using Pearson's correlation coefficient (r). Results The mean total touchtime was 403 minutes (SD, 84 minutes) at the major trauma centre and 383 minutes (SD, 103 minutes) at the elective hospital. The mean total surgical cutting time was 259 minutes(SD, 72 minutes) at the major trauma centre and 233 minutes (SD, 75 minutes) at the elective hospital, from a total available time of 510 minutes per list. There was a significant correlation between touchtime and surgical cutting time at both hospitals (elective hospital: r (198) = 0.815, p < 0.001; major trauma centre: r (198) = 0.892, p < 0.001). The mean touchtime utilisation was 79.31% for the major trauma centre and 75.20% for the elective hospital; however, the mean total surgical cutting time was 51% and 46%, respectively, of total available time. Conclusion Despite a good correlation between touchtime and surgical cutting time, the range between these measures suggests that using touchtime utilisation alone to measure theatre efficiency may not sufficiently inform about efficient practices. We suggest complementing touchtime utilisation data with surgical cutting time may provide more information to contextualise efficiencies or inefficiencies in an operating theatre.

578 Optimising Emergency Theatre Efficiency with the Use of a Pre-Anaesthetic Holding Bay, a Quality Improvement Project

Abstract Aim An efficient emergency theatre depends on the coordination of multiple surgical specialties, anaesthetists, and theatre staff. The serial nature of an operating list leads to downtime between cases. We sought to reduce delays between emergency cases by implementing a pre-anaesthetic holding bay. Method Anonymised data was collected from a prospectively maintained mandatory database of theatre activity. Exclusion criteria were non-surgical procedures, first case, out-of-hours procedures, and critical care admissions. Suitability was determined from a period pre-implementation and a pre-defined trial period to ensure safe rollout. Pre-, trial, and post-implementation were compared. Results 349 emergency procedures were performed in three months post-implementation. After exclusion criteria 110 were suitable for pre-anaesthetic holding bay use, and in 35 (31.8%) it was utilised. Most cases were general surgery (61%), vascular surgery (15%), and gynaecology (12%). Holding bay use decreased time without a patient in the anaesthetic room from 50 to 5 minutes (p&amp;lt;.001) and the time between procedures from 86 to 43 minutes (p&amp;lt;.001). There was no difference in anaesthetic time between the groups (36 vs 38 minutes, p=.40). Over the three months 40 more in-hours cases were completed in 48 days with no difference in procedures across the periods. Conclusions Pre-anaesthetic holding bay use reduced theatre downtime by 90%, allowing more procedures to be performed in-hours. All specialties engaged with the holding bay but to varying extent, and ensuring investment from surgeons, anaesthetists, and theatre staff is essential. This intervention, implemented with no extra resources, has increased efficiency and improved safety in the emergency theatre list.

1217 BiZact Tonsillectomies: An Update on Novel Technique for Efficiency Improvement

Abstract Aim Tonsillectomies represent one of the most commonly performed ENT procedures worldwide. Waiting lists throughout the NHS remain large with associated delays in treatment and increased morbidity, so we must strive to maximise our operative efficiency. In the past 2 years in our trust, we have introduced the use of the BiZact tonsillectomy device in order to increase theatre efficiency and reduce operative and wait times. We have previously presented this work and here present updated figures. Method The BiZact device has been used by a range of consultants and registrars having been proven in multiple previous studies to offer a safe alternative to conventional technique tonsillectomies. Analysis of the theatre time, “time-on-tonsil” and post-operative bleed and admission rates has been continuous. Results Previously analysed conventional tonsillectomy data showed average recorded theatre time of 36m:00s (n=72). With 103 comparable BiZact tonsillectomies performed, the average theatre time for BiZact is 13m:11s, with an average time-on-tonsil of just 4m:22s (for bilateral tonsillectomy). A post-tonsillectomy haemorrhage rate of 17.5% was recorded including those attending separate trusts. There have been 0 primary post-tonsillectomy bleeds requiring return to theatre. 24% of BiZact tonsillectomies were performed by SHOs or Registrars. Conclusions The efficiency gains offered by BiZact tonsillectomy continue to be evident as numbers increase with more being performed by junior trainees. Bleed rates remain within the range of expected adult haemorrhage rates more recently observed nationally and internationally. This has facilitated further efficiency gains in our theatre usage for tonsillectomy lists with additional cases per session.

1222 Successfully Showcasing How Digital Clinical Innovation and Enterprise Can Be Used to Improve Complex Challenges Facing the NHS - 'Creation of the ViewOP Application to Improve Theatre Utility and Efficiency'

1222 Successfully Showcasing How Digital Clinical Innovation and Enterprise Can Be Used to Improve Complex Challenges Facing the NHS - 'Creation of the ViewOP Application to Improve Theatre Utility and Efficiency'

1110 Thoracic Theatres: Audit of Theatre Efficiency

1110 Thoracic Theatres: Audit of Theatre Efficiency

Optimising operating theatre (OT) efficiency while maintaining the standardised patient care in adolescent idiopathic scoliosis (AIS) surgery with the dedicated spine team approach: a specialised spine unit experience.

To report the efficiency of OT utilisation and perioperative outcomes with a dedicated spine team approach in AIS patients who underwent posterior spinal fusion (PSF) surgeries in a consecutive case operation list. Three AIS patients operated in a day (8:00AM-8:00PM) by a dedicated spine team were recruited between 2021 and 2022. The dedicated team comprised of three senior spine consultants who operated using a dual attending surgeon strategy, an anaesthetic consultant, dedicated surgical scrub nurses, anaesthesiology nurses, radiographers, and neuromonitoring technicians. Patients were categorised according to the sequence of operation list of the day (Case 1, Case 2, and Case 3). OT efficiency was represented by OT time in five stages (preoperative time, operative time, postoperative time, total OT time, and turnover time). OT time and perioperative outcomes were compared. 102 cases were analysed. On average, Case 1 began at 8:38AM whereas Case 3 ended by 5:54PM. OT efficiency was consistent throughout the day of operation with comparable OT time in all five stages between groups (p > 0.05). The mean turnover time was 15.1 ± 13.5min and themean operative time was 123.0 ± 28.1min. Intraoperative arterial blood gas (ABG) parameters were maintained in an optimal range. Thecomplication rate was 2.0% (N = 2/102). Consistent OT efficiency was demonstrated with a dedicated spine team approach. Despite performing three AIS cases in a consecutive case operation list, patients' safety was not compromised as perioperative outcomes between groups were comparable.

Emergency surgery preoperative delays: realities, economic impacts and gains of a second emergency operating theatre.

Time-to-theatre (TTT) is a key performance indicator of theatre efficiency and delayed TTT incurs significant costs and poor clinical outcomes. An increasing Irish population in conjunction with an ageing population puts increasing pressure on emergency surgical services across Ireland. We examined our institution's experience with introducing a second emergency theatre and semi-elective theatre lists for acute surgical patients. A retrospective review of electronic, prospectively maintained databases was performed between 1 February 2018 and 31 January 2020. A cost analysis was conducted to assess the economic impact of delayed TTT. The cost-saving benefit of introducing a second emergency theatre and semi-elective Kaizen lists was then calculated and compared with 2012-2014 figures from our institution. In total, 6,679 procedures were performed. Overall mean TTT was 16h, 10h shorter than before the introduction of a second emergency theatre and Kaizen theatre lists (p < 0.001). Patients aged >65 years, who are historically a significantly disadvantaged group, had a shorter TTT following the introduction of a second emergency theatre. The economic advantage of a second emergency theatre resulted in a cost saving of €3,674,538 over 24 months. Investment in emergency surgical services resulted in more efficient access to emergency theatres. There was a reduction in out-of-hours operating across all specialties and across the more at-risk groups such as those over the age of 65, who had an overall reduction in TTT. This had significant financial benefits and likely reduced the clinical risk associated with delayed TTT and out-of-hours operating.

Towards improved theatre efficiency: a study of procedural times for common elective surgical procedures at Tygerberg Hospital

Towards improved theatre efficiency: a study of procedural times for common elective surgical procedures at Tygerberg Hospital

The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same-day case cancellation rate and associated costs.

Cancellations within 24 h of planned elective surgical procedures reduce operating theatre efficiency, add unnecessary costs and negatively affect patient experience. We implemented a bundle intervention that aimed to reduce same-day case cancellations. This consisted of communication tools to improve patient engagement and new screening instruments (automated estimation of ASA physical status and case cancellation risk score plus four screening questions) to identify patients in advance (ideally before case booking) who needed comprehensive pre-operative risk stratification. We studied patients scheduled for ambulatory surgery with the otorhinolaryngology service at a single centre from April 2021 to December 2022. Multivariable logistic regression and interrupted time-series analyses were used to analyse the effects of this intervention on case cancellations within 24 h and costs. We analysed 1548 consecutive scheduled cases. Cancellation within 24 h occurred in 114 of 929 (12.3%) cases pre-intervention and 52 of 619 (8.4%) cases post-intervention. The cancellation rate decreased by 2.7% (95%CI 1.6-3.7%, p < 0.01) during the first month, followed by a monthly decrease of 0.2% (95%CI 0.1-0.4%, p < 0.01). This resulted in an estimated $150,200 (£118,755; €138,370) or 35.3% cost saving (p < 0.01). Median (IQR [range]) number of days between case scheduling and day of surgery decreased from 34 (21-61 [0-288]) pre-intervention to 31 (20-51 [1-250]) post-intervention (p < 0.01). Patient engagement via the electronic health record patient portal or text messaging increased from 75.9% at baseline to 90.8% (p < 0.01) post-intervention. The primary reason for case cancellation was patients' missed appointment on the day of surgery, which decreased from 7.2% pre-intervention to 4.5% post-intervention (p = 0.03). An anaesthetist-driven, clinical informatics-based bundle intervention decreases same-day case cancellation rate and associated costs in patients scheduled for ambulatory otorhinolaryngology surgery.

The provision of a trauma bed in theatre recovery and its impact on trauma theatre efficiency: experience from a high-volume trauma unit.

Inefficiencies in the trauma setting are well known and have been further exacerbated by the COVID-19 pandemic among other factors, resulting in national guidance to aid improvements in resource utilisation. This study introduced a novel surgeon-led intervention, a trauma bed in recovery, with the aim of improving trauma theatre efficiency. This quality improvement project was conducted using a Plan Do Study Act (PDSA) methodology and comprised multiple cycles to assess theatre performance. A multidisciplinary team (MDT) approach with relevant stakeholder input enabled intervention implementation, aimed at facilitating 'golden patient' arrival in the anaesthetic room as early as possible. The primary outcome was the time at which the first patient entered the anaesthetic room, and the secondary outcome was the number of cases performed each day. The study period was 1 year and encompassed three PDSA cycles. The intervention achieved its primary outcome by PDSA cycle 1 and its secondary outcome by PDSA cycle 2, demonstrating statistically significantly improved results (p < 0.001). A subanalysis assessed the specific impact of the intervention, and demonstrated a significant improvement in both outcomes when the intervention was used as intended (p < 0.0005). A ringfenced trauma bed significantly improved theatre start times and thereby theatre efficiency. This is a simple, pragmatic intervention that benefitted the MDT trauma team while also demonstrating a sustained impact. Given that National Health Service efficiency is at the forefront of national healthcare discourse, we recommend that this intervention is implemented in other trauma units to help provide a solution to this longstanding issue.

The Relevance of World Health Organization Surgical Safety Checklist to Spinal Surgery

Across the 193 member states of the World Health Organization (WHO) an estimated 234 million operations were conducted worldwide in 2008 (1 per every 25 human beings on the planet). These numbers have continued to increase to 312.9 million by 2016. Surgical errors involving the wrong site, wrong procedure or wrong patient occur at a rate of 1 in 112,000. This equates to 2,000 estimated ‘never events’ every year with a significant associated physical and psychological burden on patients and surgeons and financial and reputational burden on health organisations involved in litigation for such errors. The WHO Surgical Safety Checklist (WHOSSC), produced in 2009 is now synonymous with safety in the operating theatre. This checklist imposes a process of scrutiny at the key steps of the patients journey through theatre. The key details scrutinised have been shown to improve patient outcomes and theatre efficiency. Several studies have looked at adapted checklists specific to different specialties and it is becoming clearer that whilst the overall benefit of the original checklist is undeniable, in some speciality areas a more deliberate and nuanced application of the checklist to address specific problems could be of value. As a specialism, spinal surgery differs from others with a significant risk of a perioperative complication leading to harm and morbidity, permanent disability or even death. Iatrogenic spinal cord injury requires high-level resources and prolonged, sometimes lifelong rehabilitation. Other complications include cerebrospinal fluid leak, blood loss, new neurologic deficit, hardware failure, proximal junctional failure, pseudarthrosis, and surgical site infection. Wrong level spinal surgery (WLSS) is a complication specific to spinal surgery and studies have reported WLSS effecting 50-68% of spinal surgeons at some point in their career. The risks of these complications can be mitigated by factors, some of which are included in the WHOSSC and others with are lacking. This scoping review looks at how surgical checklists; both the original and modified versions have and could be used to address the surgical safety challenges specific to spinal surgery.

Transcutaneous ultrasound level check for selective dorsal rhizotomy.

Single-level selective dorsal rhizotomy (SDR) surgery requires an intra-operative level check to identifythe L1 vertebral level or the conus medullaris. Typically, this requires a pre-operative or intra-operative x-ray. We present our experience using initial transcutaneous ultrasound as an alternative to x-ray level check. A prospective SDR database was used to identify patients. The operation notes were reviewed to identify the level check method and any complications or wrong-level surgery. Data are reported for the first 160 SDR surgeries performed within our centre, mean age 6.47 years (range 2.5-19 years). The first 11 patients had combined x-ray and transcutaneous ultrasound for pre-incision level check. This allowed the neurosurgeon to assess the accuracy and feasibility of using transcutaneous ultrasound instead of x-ray. The subsequent 149 patients had ultrasound alone for transcutaneous pre-incision level check. An intra-operative ultrasound level check was performed for all patients following skin incision and dissection down to the spinal lamina. In this way, the conus level was confirmed before dural opening. For all patients at all ages, the combination of initial transcutaneous ultrasound followed by intra-operative ultrasound allowed accurate identification of the conus. There were no instances of wrong-level surgery. Learning points are presented within this paper. Combined use of transcutaneous ultrasound followed by intra-operative ultrasound can allow accurate identification of the conus, saving radiation exposure and potentially improving theatre efficiency. Appropriate training and experience are required for any neurosurgeon using these techniques.

Virtual reality laparoscopic simulation for operating theatre efficiency: an outcome logic model program evaluation

This article describes introduction of a comprehensive laparoscopic simulation education program to enhance operative efficiency in gynaecological procedures. We describe our approach to educational design, clinical integration and evaluation using an outcome logic model. The study was conducted at Gold Coast Hospital Health Service (GCHHS) following the purchase of a laparoscopic virtual reality (VR) laparoscopic simulator (LAPSIM® VR), and development of a training program for obstetrics and gynaecology (O&amp;G) trainees. In 2021, a surgical laparoscopic credentialling simulation program was introduced, requiring trainees to achieve a ‘pass’ on the LAPSIM® VR simulator prior to operating on patients. The evaluation approach used an outcome logic model to document program objectives and outcomes. Data analysis involved multivariate linear regression to ascertain the impact of the laparoscopic simulation program on procedure length in the operating theatre. Inputs included faculty and trainee time, space, LAPSIM® VR equipment and take-home laparoscopic box trainers. Activities involved online instructional modules, training and surgical learning sessions. Outputs included trainee utilization of LAPSIM® VR and credentialling. Outcomes included surveys, retrospective reviews of patient laparoscopic salpingectomies and primary surgeon operator rates. LAPSIM® VR credentialling was performed by 81% of the GCHHS gynaecology registrar cohort in 2021. Trainees completed 234 VR salpingectomies. Introduction of the LAPSIM® VR program was associated with a significant reduction in mean operative time for all ectopic pregnancies in all primary surgeon groups. For uncomplicated ectopic procedures, there was a reduction in operative time of 14 minutes between 2020 and 2021 ( Introduction of a laparoscopic simulation VR credentialling program resulted in a significant reduction in operative time for laparoscopic salpingectomies in our institution. Educational programs should aspire to translational, patient-focused outcomes in their design and delivery.

Measuring and reporting theatre utilization and efficiency.

Measuring and reporting theatre utilization and efficiency.

A STUDY OF POST-OP HEMIARTHROPLASTY DISLOCATIONS AT A DISTRICT GENERAL HOSPITAL

AbstractBackground1. 63,284 patients presented with neck of femur fractures in England in 2020 (NHFD report 2021)2. To maximise theatre efficiency during the first wave of COVID-19, NHSE guidance recommended the use of HA for most patients requiring arthroplasty.3. The literature reports an incidence of Hemiarthroplasty dislocations of 1–15%.Aims1. To study the number and possible causes of dislocations in patients with Primary hemiarthroplasty for fracture neck of femur2. To compare our data with national and international data in terms of dislocation and revision rates for Hemiarthroplasty.MethodsRetrospective study Duration- 1st April 2021–31st March 20223. Inclusion criteria- Patients with neck of femur fracture treated with Hemiarthroplasty. Exclusion criteria- Patients treated with other surgical options for neck of femur fracturesResults1. No. of neck of femur patients- 4442. No. of patients treated with Hemiarthroplasty- 2143. No. of dislocations- 44. 75% were female, 75% had AMTS&gt;7, 50% were operated within 36 hours of trauma, 75% dislocated within a month of surgery, 75% of the dislocations were revised. 5. One dislocation was due to &gt;72 hour delay to surgery, second dislocation was due to smaller offset and shortening, third was due to acetabular dysplasia, fourth was due to larger head used. Discussion-1. Our 1.86% dislocation rate matches that in the literature of 1–6%2. 75% dislocated within a month of surgery matches that in the literature that maximum dislocations occur within one month. 3. Closed reduction as definitive method of management of dislocation 25% matches that in the literature of 22–25%4. 75% dislocations revised similar to literature of 75–80% revision rate.ConclusionPre-operative templating can reduce surgical error involving limb length discrepancy and shortening to prevent dislocationsDeclaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

235 Late Start Times Do Not Disproportionately Prolong Operating Times in Major Head and Neck Reconstruction

Abstract Introduction Operating start time delays are deemed as having a detrimental effect on theatre efficiency, subsequent delays, costs, and potentially outcomes. This study assessed the significance of delayed operating start times on major head and neck reconstruction cases and whether later starts led to disproportionately later finishes. Focus was placed on free osteocutaneous fibula flap reconstruction due to long operating times, difficult anaesthesia, frequently overrun and the perception of increased morning efficiency. Method Single centre identification of 26 patients using coding informatics that were diagnosed with an intra oral malignancy or osteoradionecrosis requiring reconstruction with a free osteocutaneous fibula flap. Data was manually retrieved between 2015 to 2020 from electronic patient records and statistical analysis was completed using Microsoft Excel. Results Total number of patients collated was 27, however 1 was excluded due to insufficient electronic logging of patient data. The total mean age was 64.8 (40-79), 50% were male (13) and 50% were female (13). The mean start time was 9:57, end time was 18:52 and duration was 10:50 (4:46 to 13:42). For surgery start times before 10:00 a.m. the mean start time was 9:31, end time was 20:16 and duration was 10:46 (8:30 to 22:56). For surgery start times after 10:00 a.m. the mean start time was 10:22, end time was 19:25 and duration was 10:54 (10:01 to 00:51). Conclusions Delayed operating start times have minimal significance on theatre efficiency and don’t disproportionally prolong operating times in major head and neck reconstruction cases.

840 Digital Consent: Does It Have a Role in the Perioperative Workflow?

Abstract Aim Paper consent processes often contain errors of omission, illegibility, and unwarranted variation. Missing paper-consent forms can cause delays, cancellations, and poor theatre efficiency. Digital consent reduces errors, empowers patients in clinical decision discussions and improves patient perception of Shared Decision Making (SDM). This study evaluates the roll-out of the Concentric Health digital consent application in 2022. Method Consent episode data was assessed from a one-year period (1st January 2022 - 18th December 2022) using Concentric analytics. Qualitative data was obtained via optional patient satisfaction surveys. Results 63,024 consent episodes were created during the period, amounting to 51,424 completed consent episodes for 4,021 unique procedures by 1,427 clinicians across 28 specialties from 38 healthcare providers. Of the completed episodes, 36.8% were completed in advance of the day-of-surgery. 22.9% of episodes were remote. Patients were aged 0-103 years, (median 56, IQR 31). Treatment information was shared digitally with 77.7% of patients. The average patient satisfaction rating was 4.6 out of 5 (1 very poor - 5 very good, n = 8359). Conclusions Concentric has been introduced into practice across multiple hospitals and clinical environments, with patients reporting high satisfaction scores. Remote consent is feasible, being used by nearly a quarter of patients. Digital consent facilitates consent in advance of the day-of-surgery, giving patients adequate time for consideration and possibly optimising theatre efficiency. Digital consent applications can be considered for adoption across all units to capitalise on these benefits. Further work will investigate demographic effects on satisfaction scores.

928 The Golden Patient: A Concept to Improve Trauma Theatre Efficiency

Abstract Aim Golden patient (GP) is a pre-selected first patient on the next day’s trauma theatre list, with suitable medical fitness and a clear surgical plan. This study aimed to evaluate whether the GP concept improved the start times of theatre lists and the operating efficiency of the Aberdeen trauma unit. Method This prospective study compared theatre starting times before and following an intervention to improve consideration of the GP concept among both trauma and theatre staff. Data was collected from pre-planned trauma theatre lists on Bluespier software the evening before and the morning of the list. The comparative mean of operation start times between the groups was established and a two-sided t-test was performed to evaluate the significance between the groups. Results Post-interventional analysis identified 32 GPs out of which 28 persisted as first patients on the lists. The remaining 4 patients were deferred either due to an overnight emergency that took priority or a change in medical status that required them to be moved down the list. The mean operation start time was 10:00 compared to 10:14 pre-intervention. Further, in the re-audit, the mean operation start time was reduced by 39 minutes (p&amp;lt;0.01) when the GP remained first on the list. Conclusions The concept of GP has improved the theatre start times which is further evident in the delay to the start of the list when the GP is not employed. Additional contributing factors that influence theatre efficiency and require further review include anaesthetic planning, patient transport and others.

SP3.3 Digital Consent: a review of two years of implementation &amp; its impact on the perioperative workflow

Abstract Aims Paper consent processes have been demonstrated to contain errors of omission, illegibility and unwarranted variation. Missing paper-consent forms can cause delays, cancellations and poor theatre efficiency. Digital consent is known to reduce errors, empower patients in clinical decision discussions and improve patient perception of Shared Decision Making. This study evaluates the roll-out of Concentric Health’s digital consent application over a two year period. Methods Consent episode data was assessed from a two year period (27th January 2021 - 26th January 2023) using Concentric analytics. Qualitative data was obtained via optional patient satisfaction surveys. Results 96,710 consent episodes were created during the period, amounting to 79,476 completed consent episodes for 3029 unique procedures by 1193 clinicians, across 27 specialties from 43 healthcare providers. Of the completed episodes, 44.1% were completed in advance of the day-of-surgery. 22.5% of episodes were remote. Patients were aged 0-105 years, (median 60, IQR 43). Treatment information was shared digitally with 77.1% of patients. The average patient satisfaction rating was 4.61 out of 5 (1 very poor - 5 very good, n = 10007). Conclusions Concentric is being used in practice across multiple hospitals and clinical environments, with patients reporting high satisfaction scores. Digital consent enables consent in advance of the day-of-surgery, affording patients sufficient time for consideration, and possibly optimising theatre efficiency. Remote consent is feasible, used by over a fifth of patients. Digital consent applications can be considered for adoption in all units to capitalise on these benefits.

The Golden Patient Initiative: A Systematic Review.

Operating theatres and surgical resource consumption comprise a significant proportion ofhealthcare costs. Inefficiencies in theatre lists remain an important focus for cost management, along with reducing patient morbidity and mortality. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, the number of patients on theatre waiting lists has surged. Hence, there is a pressing need to utilise the already limited theatre time and fraught resources with innovative methods. In this systematic review, we discuss the Golden Patient Initiative (GPI), in which the first patient on the operating list is pre-assessed the day prior to surgery, and we aim to assess its impact and overall efficacy. A literature search using the following four databases was conducted to identify and select all clinical research concerning the GPI: Medical Literature Analysis and Retrieval System Online (MEDLINE),Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), and the Cochrane library. Two independent authors screened articles against the eligibility criteria, using a process adapted from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data extracted included outcomes measured, follow-up period, and study design. The results showed significant heterogeneity, and hence a narrative review was conducted; 13 of the 73 eligible articles were included for analysis. Outcomes included delay in theatre start time, number of surgical case cancellations, and changes to total case numbers. Across the studies, a 19-30-minute improvement in theatre start time was reported (p<0.05), as well as a statistically significant decrease in case cancellations. Our analysis provides encouraging conclusions with regard to greater theatre efficiency following the application of GPI, a low-cost solution that can easily be implemented to help improve patient safety and lead to cost savings. However, at present, it is largely implemented amonglocal trusts, and hence larger multi-centre studies are required to gather conclusive evidence about the efficacy of the initiative.