Table 4 Examples of strategies used by surgical teams to control and prioritise demand
Theme | Strategy | Example |
|---|---|---|
Control Demand | ||
Anticipatory | Suspending or restricting services through planned cancellations of surgery | Cancelling elective surgery or standing down theatres used for less urgent surgery to make way for emergency surgery or fast-track patients Doing fewer surgeries in anticipation of forthcoming pressures in a few days’ time |
Discharging patients sooner from surgical wards to create space for anticipated need | If the surgical ward is full, patients for anticipated discharge tomorrow are reviewed today to expedite discharge to make beds available for emergency patients the next day | |
On-the-day | Cancelling surgeries on the day | Incoming emergencies or staff sickness meant surgeries were cancelled on the day |
Restricting admissions to the ward | Restricting additional patients coming onto a full ward by having them cared for in recovery for longer, and start times for the next surgeries are pushed back | |
Prioritising Demand | ||
Anticipatory | Referring to national systems for prioritising patients by clinical need and wait time | Patients are prioritised from P1 (most urgent) to P4 (least urgent). P2 would include cancers and urgent surgery; P3 patents should be seen within 3 months. Patients who had had their surgery cancelled should be rescheduled for surgery within 28 days |
On-the-day | Prioritisation of patients when theatre space became available on the day | Ad hoc meetings of surgeons or multidisciplinary team discussions, to decide which patients ought to be prioritised when a spare theatre or post-operative bed became available on the day |