Background

In August 2010 a one day workshop was held to look at patient flow through theatres.  Prior to the workshop the hospital's service improvement team had identified a widespread perception that the recovery bay was the primary inhibitor to patient flow.  However, a number of other issues concerned the improvement team, in particular that theatres were sometimes unaware of the location of their patients when they send for them thus delaying the process; that all 22 theatres are sending for their patients from the holding bays at the same time whilst resources (staff) are insufficient to be able to retrieve all patients at the same time; that even when patients are prepped and ready, the messages to pull patients are not getting through because staff are not answering the phone.  During the afternoon theatre list, recovery bays become blocked and theatre staff are unable to send patients to recovery and thus theatre bays also become blocked.

SimLean Educate

The hospital requested the use of SimLean Educate to consider the impact of the following upon patient flow:

• Batched arrivals vs spreading patient arrivals across the day
• Prioritising patients 
• Sharing resources  vs dedicated resources

Outcome

Despite the time constraints of the workshop, the ideal of 'one-patient flow' was discussed in brief with many feeling that this is unrealistic.  The intention to move towards a 'staggered' approach to patient arrivals was seen as a positive step towards improving patient flow as a result of the use of SimLean Educate.