Guy's & St Thomas' Foundation Trust: Surgical HIT lists do 'a month's worth' of surgeries in a day (2 August 2022)

Summary

Clinicians at Guy's & St Thomas' Foundation Trust in London are preparing to publish the results of 15 one-day HIT lists between February 2021 and August 2022, involving 300 patients across eight different specialties, in which they claim they have been able to carry out four times as many operations as they would normally expect to complete in a month using conventional lists.

Content

The HIT lists - which have been designed by Dr Imran Ahmad, consultant anaesthetist and deputy clinical director for Theatres, Anaesthetics, & Peri-operative medicine at Guy's and St Thomas', to eliminate 'turnaround time' - were inspired by Formula 1 motor-racing pitstop techniques, to achieve maximum efficiency and safety, by boosting the surgeon’s operating time (the most expensive and most scarce resource) from the 40% per session of a conventional list to an unexpected 90%, and eliminating all possible patient delays on the day.

Dr Ahmad - working with his colleague Dr Kariem El-Boghdadly - confesses that the success of the HIT lists has exceeded his expectations. The one-day Saturday events at three sites across the Guy's and St Thomas' trust, have consistently delivered four times the number of operations normally expected using conventional 'one-surgeon one list' methods. No short-term or long-term complications have been observed and there were only two on-day cancellations across eight speciality areas (including gastrointestinal, gynaecology, orthopaedics, and ear nose and throat).

The HIT lists are always scheduled for a Saturday, in order not to put pressure on the routine working of the Trust, and have used only volunteer surgeons, working to the following model:

• Clinician led.
• Two theatres with one surgeon and three surgical teams.
• Single centre environment, eliminating potential delays such as porters.
• 50% more theatre staff than two conventional lists.
• Specially-selected low-risk patients.
• Best results with operations lasting 30-45 minutes.
• Single speciality list.
• Intense list planning for maximum efficiency.
• Several pre-op meetings with patients to inform them, gain consent, eliminate risk factors, and arrange post-operative medication.
• Lists always finish at least 1 hour (sometimes 3 hours) before the end of the shift.