scholarly journals Economic modelling of immediately sequential bilateral cataract surgery (ISBCS) in the National Health Service based on possible improvements in surgical efficiency

2020 ◽  
Vol 5 (1) ◽  
pp. e000426 ◽  
Author(s):  
David P O'Brart ◽  
Harry Roberts ◽  
Khayam Naderi ◽  
Jack Gormley
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Cataract Surgery ◽  
National Health ◽  
High Volume ◽  
Economic Modelling ◽  
Bilateral Cataract ◽  
Motion Data ◽  
Time And Motion ◽  
Motion Study

ObjectiveTo test a hypothesis that operating room (OR) productivity in the National Health Service (NHS) can be improved with the introduction of immediately sequential bilateral cataract surgery (ISBCS).Methods and analysisPreviously published time and motion data of 140 unilateral cataract surgeries conducted at five different NHS locations were reanalysed to construct a hypothetical model where only ISBCS (±one unilateral case) were conducted while maintaining time durations of all key tasks previously studied. Possible time efficiency savings were calculated for the ISBCS model and percentage increases in numbers of eyes operated per 4-hour theatre session calculated. Gains in efficiency were correlated with factors from the baseline data to predict which settings could improve efficiency most by undertaking ISBCS.ResultsBased on remodelling our time and motion study (TMS) data as hypothetical ISBCS cases, we could expect a mean 16% reduction (range 9.8%–17.8%) in the time taken for two cataract operations, translating into a mean 54% improvement (range 38%–67%) in number of cases currently performed per list and an 18% improvement (range 9%–28%) even if the number of unilateral cases per list had been fully maximised. An average number of four ISBCS cases per list (range 3–6) were required to achieve sufficient time savings to allow an extra unilateral surgery to be conducted.ConclusionThe introduction of routine ISBCS has the potential to improve the productivity of cataract surgery within the NHS, with efficiencies being possible in both high-volume and low-volume surgical models.

scholarly journals Time and motion studies of National Health Service cataract theatre lists to determine strategies to improve efficiency

2017 ◽  
Vol 102 (9) ◽  
pp. 1259-1267 ◽  
Author(s):  
Harry W Roberts ◽  
James Myerscough ◽  
Simone Borsci ◽  
Melody Ni ◽  
David P S O’Brart
Keyword(s):  
National Health Service ◽  
Linear Regression ◽  
Health Service ◽  
Multiple Linear Regression ◽  
National Health ◽  
Multiple Linear Regression Model ◽  
High Volume ◽  
Time And Motion Studies ◽  
Time And Motion ◽  
Motion Studies

AimTo provide a quantitative assessment of cataract theatre lists focusing on productivity and staffing levels/tasks using time and motion studies.MethodsNational Health Service (NHS) cataract theatre lists were prospectively observed in five different institutions (four NHS hospitals and one private hospital). Individual tasks and their timings of every member of staff were recorded. Multiple linear regression analyses were performed to investigate possible associations between individual timings and tasks.Results140 operations were studied over 18 theatre sessions. The median number of scheduled cataract operations was 7 (range: 5–14). The average duration of an operation was 10.3 min±(SD 4.11 min). The average time to complete one case including patient turnaround was 19.97 min (SD 8.77 min). The proportion of the surgeons’ time occupied on total duties or operating ranged from 65.2% to 76.1% and from 42.4% to 56.7%, respectively. The correlations of the surgical time to patient time in theatre was R2=0.95. A multiple linear regression model found a significant association (F(3,111)=32.86, P<0.001) with R2=0.47 between the duration of one operation and the number of allied healthcare professionals (AHPs), the number of AHP key tasks and the time taken to perform these key tasks by the AHPs.ConclusionsSignificant variability in the number of cases performed and the efficiency of patient flow were found between different institutions. Time and motion studies identified requirements for high-volume models and factors relating to performance. Supporting the surgeon with sufficient AHPs and tasks performed by AHPs could improve surgical efficiency up to approximately double productivity over conventional theatre models.

Cataract surgery refractive outcomes: representative standards in a National Health Service setting

2018 ◽  
Vol 103 (4) ◽  
pp. 539-543 ◽  
Author(s):  
Kerr Brogan ◽  
Charles J M Diaper ◽  
Alan P Rotchford
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Cataract Surgery ◽  
National Health ◽  
Postoperative Outcome ◽  
Absolute Error ◽  
European Guidelines ◽  
Refractive Outcomes ◽  
Service Setting ◽  
The Mean

Background/aimsTo report refractive outcomes from an National Health Service (NHS) cataract surgery service and assess if results meet suggested benchmark standard.MethodsDetails of all patients undergoing cataract surgery in the Southern General and New Victoria hospitals in Glasgow, UK, between November 2006 and December 2016 were prospectively entered into an electronic database. Patients were reviewed 4 weeks postoperatively in the eye clinic and underwent refraction at their local optometrist prior to this appointment. Surgically uncomplicated cases with in the bag’ non-toric intraocular lens implantation were included. Patients with previous laser refractive procedures or failing to achieve 6/12 acuity or better postoperatively were excluded. Proximity to targeted postoperative refraction was documented.ResultsOver this 10-year period, 11 083 eyes underwent cataract surgery. Of these, 8943 eyes of 6936 patients (80.69%) met the inclusion criteria and had both target and postoperative outcome refraction recorded. The mean difference between the targeted and outcome refraction was −0.07 D (SD 0.67). The mean absolute error was 0.50 D. Postoperative refraction was within 1 D of target refraction for 7938 eyes (88.76%) and within 0.50 D for 5577 eyes (62.36%).ConclusionRefractive outcomes following routine cataract surgery reported here are well within the targets recommended by the Royal College of Ophthalmologists and European guidelines, but suggest that higher cataract refractive outcome benchmark standards may not yet be a realistic expectation for all NHS units with current biometry practice.

High Volume Acupuncture Clinic (Hvac) for Chronic Knee Pain – Audit of a Possible Model for Delivery of Acupuncture in the National Health Service

2008 ◽  
Vol 26 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Saul Berkovitz ◽  
Mike Cummings ◽  
Chris Perrin ◽  
Rieko Ito
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Knee Pain ◽  
National Health ◽  
Large Scale ◽  
High Volume ◽  
Clinical Results ◽  
Group Setting ◽  
Chronic Knee Pain ◽  
One Year

Recent research has established the efficacy, effectiveness and cost effectiveness of acupuncture for some forms of chronic musculoskeletal pain. However, there are practical problems with delivery which currently prevent its large scale implementation in the National Health Service. We have developed a delivery model at our hospital, a ‘high volume’ acupuncture clinic (HVAC) in which patients are treated in a group setting for single conditions using standardised or semi-standardised electroacupuncture protocols by practitioners with basic training. We discuss our experiences using this model for chronic knee pain and present an outcome audit for the first 77 patients, demonstrating satisfactory initial (eight week) clinical results. Longer term (one year) data are currently being collected and the model should next be tested in primary care to confirm its feasibility.

Advanced Nursing Practice in Großbritannien – eine persönliche Schilderung

Pflege ◽  
2010 ◽  
Vol 23 (6) ◽  
pp. 417-423
Author(s):  
Elke Keinath
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Nurse Practitioner ◽  
Nursing Practice ◽  
Advanced Nursing Practice

Im Artikel werden persönliche Erfahrungen als Advanced Nurse Practitioner (ANP) in der Thoraxchirurgie im National Health Service (NHS) in Großbritannien geschildert. Die tägliche Routine wurde von sieben Kompetenzdomänen bestimmt, nämlich: Management des Gesundheits- und Krankheitszustandes des Patienten, Beziehungen zwischen Pflegeperson und Patient, Lehren und Unterrichten, professionelle Rolle, Leitung und Führung innerhalb der Patientenversorgung, Qualitätsmanagement sowie kulturelle und spirituelle Kompetenzen. Diese Elemente wurden durch die Zusatzqualifikation, selbstständig Medikamente verschreiben und verordnen zu dürfen, erweitert, was dazu beitrug, eine nahtlose Erbringung von Pflege- und Serviceleistungen zu gewähren. Die Position wurde zur zentralen Anlaufstelle im multi-professionellen Team und stellte eine kontinuierliche Weiterführung der Pflege von Patienten und ihren Familien sicher – auch über Krankenhausgrenzen hinweg.

76-OR: UK 1st National Health Service (NHS) EndoBarrier (EB) Service for Uncontrolled Diabesity: 2-Year Outcomes for All 62 Treated Patients

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 76-OR
Author(s):  
ROBERT E.J. RYDER ◽  
MAHENDER YADAGIRI ◽  
SUSAN P. IRWIN ◽  
WYN BURBRIDGE ◽  
MELANIE C. WYRES ◽  
...  
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health
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