How a clinical and industry collaboration in Ireland eliminated risk by embracing new healthcare concepts to improve patient outcomes.

The time a patient must wait for access to non-urgent care has been a longstanding challenge with huge variations across Europe ranging from 20-80% waits over 3 months for common surgical procedures[i], even before the arrival of Covid-19. The Royal College of Surgeons claims it has been five years since the English NHS has met 18-week waiting-time targets[ii] and recently described waiting times for planned surgery in Northern Ireland as ‘shocking’[iii]. Discussions across Europe to improve the supply disparity of elective surgical services have continued for many years with the main concern centering on the implications of patients’ long-term health outcomes caused by the delays.

Tallaght University Hospital (TUH), one of Ireland’s largest acute teaching hospitals located in Dublin, provides acute care provision for a growing patient population that includes a large ageing cohort, three times above the national average rate. It has a strong surgical track record but was frequently challenged by the cancellation of planned surgical cases by emergency admissions taking recovery beds. This was leading to spiralling waiting lists of up to 36 months in some specialities and creating frustrations for both patients and clinical care teams.

An ambitious and ahead-of-its-time new facility project ensued to effect change and overturn the long patient-waiting times for elective surgical care. This saw the selection of a ready built, vacant office building three minutes’ walk from the main hospital site in a ‘health quarter’ of the town. It was transformed into a 3,460m² separate day-surgery centre consisting of 4 theatres and 25 recovery beds with dedicated surgical teams.

Key challenges:

322% predicted population growth of over 75-year-olds by 2036 compared to national figure of 105%[iv]
High % of patient population from areas of high deprivation with high incidence of chronic disease
Construction of additional local housing schemes projected to further grow patient numbers
Unexpected admissions from ED swallowing up elective surgery bed capacity leading to increasing rates of cancelled day surgery
Patient waiting times of up to 36 months (3 years)
Growing frustrations within internal surgical and nursing care teams

Positive outcomes:

Separation of acute and elective care in-line with Ireland’s national Sláintecare[v] health policy
Total number of theatres increased from 12 to 16
25 dedicated day-surgery beds ringfenced from ED admissions
Patient waiting times reduced to 12 weeks
80% of day surgery performed in dedicated centre
Extra capacity of acute hospital theatres designated to trauma support status
Zero patient complaints since opening Reeves Day Surgery Centre
Happy surgeons and nurses focused back onto uninterrupted patient care

Minister officially opening RDSC.jpg

A standalone day-surgery centre closer to the community

Within five months of opening, it has seen over 800 patients and 80% of day-surgery activity across all surgical specialities is now performed in the new centre. It is on track to reduce day-surgery waiting times to the gold-standard figure of 12 weeks by the end of its first year and create 0.8-1.2% spare theatre capacity that can be offered to other hospitals or local care groups to help alleviate wider community healthcare pressures.

“To tackle our escalating surgical waiting lists, we had two options: the creation of a new on-site hospital facility for day surgery, or, think differently and separate our acute and elective surgical care by cascading provision a little further out into the community,” states Shane Russell, Chief Operations Officer at TUH. “More beds on-site ran the risk of history repeating itself in the future with elective surgery bed capacity once again getting absorbed by acute cases. So, we opted for a new off-site and ready-built location to protect beds from any in-hospital pressures and quickly gain surgical care capacity without needing to wait for a new build project. The Reeves Day Surgery Centre was born.”

Delivering value to patients and preserving hospital reputation

The main objective for the day-surgery centre was to bring down patient waiting times by removing the potential for procedure cancellations or rearrangements due to inpatient pressures. In the separate surgical hub the beds are safeguarded for same-day surgical recovery purposes only and cannot be encroached on by acute admissions.

This has been achieved since its opening in December 2020, and wider benefits have also been delivered from a staffing retention and morale perspective while protecting the hospital’s professional reputation through fulfilling on its core values to patients.

“For patients walking into the Reeves Day Surgery Centre it feels just like what they would get in the private sector - a modern five-star hotel experience in a state-of-the-art clinical facility. It gives patients a positive experience right from the start of their surgical journey. A high-quality experience is what they deserve to assure them that they are getting a high-standard of care,” states Sean Humphreys, Programme Manager at TUH. “The opening has also helped the hospital meet wider strategic aims too. We have recently been designated as a trauma centre in Ireland and this has been made possible, in part, by the redesign of our surgical care services. It means that our 12 acute hospital theatres are totally freed up from elective day surgery to better deal with unexpected trauma cases. This will better serve the whole patient community and beyond.”

“As an acute teaching hospital, we have a commitment to our patients and staff. Patients expect and deserve timely treatment to improve their health outcomes, and our clinical teams deserve respect to be given to their profession. If things had continued the way they were with regular cancellations of surgical appointments, our surgeons in training would not have even achieved the mandatory figures for their procedure log books – this would have been a huge waste of talent and clinical care. The transformation of our day surgery services beyond the traditional walls of the hospital was essential and had to be clinically led,” states Lucy Nugent, Chief Executive Officer at TUH.

Providing a patient perspective Patricia Morrison, Assistant Director of Nursing and Cait Tobin, Clinical Nurse Manager who lived and breathed every detail of the patient centred solution state, “The impact of rescheduling appointments can cause disruption and anxiety to patients – some may have arranged time off work or planned childcare in advance, not to mention the frustration of fasting before a procedure and travelling to the hospital only to find it cancelled at short notice.”

“Furthermore, the time factor on nursing staff of having to cancel and rebook procedures is a huge inefficiency in the hospital environment. It took many hours of administrative time that should have been time spent on patient care. Our surgeons and nurses took the backlash from patients venting their emotions from cancellations very personally and this is not good for morale. The difference now is so satisfying – in just 12 months from opening we will be on top of our 18-month backlogs and at the gold-standard of 12 weeks for patient waiting times. Now we have happy patients and happy surgeons,” they add.

Collaboration creating certainty during a high-risk project

“Despite Covid-19’s best attempts it did not delay the project. Our aim was for opening in the last quarter of 2020 and we achieved this despite the pressures on the hospital site and the redeployment of project teams as part of our Covid responses,” states Shane Russell, Chief Operations Officer at TUH. “The Reeves Day Surgery Centre was actually well timed for the unexpected arrival of an infectious disease pandemic as it was considered a much lower-risk facility than the acute hospital as a separate building and the flow of patients throughout the facility had already been designed to be one-directional. It was in fact the only area of our hospital that was not impacted in the 2020/21 winter wave of Covid-19.”

Partnership working by drawing together the skills and viewpoints of operational and clinical teams from within the internal hospital environment, plus specialist external GE Healthcare program management, resulted in a collaboration that achieved all the objectives on time, even overcoming unexpected obstacles such as Covid-19 along the way. To the delight of all involved, the project recently gained external recognition as the 2021 Public Sector Project of the Year at the Ireland Chapter of Project Management Institute’s (PMI) National Project Awards, held in partnership with PwC.[vi]

“This has been a great partnership built on trust and sharing the risk to achieve positive outcomes in challenging times. It went far beyond the usual elements of supply, installation and financing of medical technology, to include program and project management for the design and build of the facility plus data modelling for decision making,” states Chris Joynt, General Manager, GE Healthcare Ireland. “When we asked the team at TUH what advice they would give to others starting out on a similar journey, it was to ‘be brave’ and ‘dare to dream big’. Close collaboration with industry helps with this by providing greater confidence and risk management.”

Professor Paul Ridgeway, Clinical Director at TUH adds, “Working with GE Healthcare gave us the rigour to land our goals and get back to where we were previously – delivering high-quality pioneering complex day surgery. It helped guide us in the process changes that were needed alongside the physical bricks and mortar of a new unit, plus introduced data modelling and scenario planning to support our decision making. This enabled the new model of a standalone day-surgery hub to go live on time and start making a difference to patient care from day one.”

“By moving services into the community, we have created almost a drawbridge between the acute setting and the day surgery centre,” states John Kelly, Deputy Chief Executive Officer at TUH. “During the biggest Covid wave to hit Ireland in January 2021, we could simply lift that drawbridge and allow day surgery to continue uninterrupted as a low-risk activity, while the main hospital dealt with one of the most challenging situations in its history.”

Fit for the future with tools to plan ahead

“With a state-of-the-art surgical centre, renewed energies and advanced planning tools, we’re in great shape for the future. The capacity utilisation modelling that GE Healthcare introduced can now enable us to schedule and plan ahead by looking at the length of procedures and resource availability,” states Angela Clayton Lea, Operational Lead for the Perioperative Directorate at TUH. “This has given clarity and certainty in the decisions we make and has already enabled us to build on the initial success of bringing down waiting lists by broadening the surgical specialities offered. Plus, our capacity forecasts are that by later this year we will have spare theatre capacity that can be offered to other national health care organisations to relieve surgical bottlenecks beyond our own region.”

Finally, Sinead Vaughan, Clinical Nurse Manager who oversees The Reeves Day Surgery Centre now that is operational states, “People love coming to work here - they get the opportunity to do the work that they were trained to do and not to spend hours cancelling and rescheduling patient appointments. Watching the waiting list fall away is so satisfying for everyone involved.”

Find out how GE Healthcare can support you in building standalone Community Diagnostic Hubs (CDH) and Surgery Centres #Shaped Around You - Explore our DiagnostiCARE offering and use our CDH planning tool to create a bespoke recommendations report.

[i] Waiting Times for Health Services: Next in Line, OECD Health Policy Studies, OECD Publishing, 2020, https://doi.org/10.1787/242e3c8c-en

[ii] Royal College of Surgeons in England April 2021, https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/waiting-times-feb-2021/

[iii] Royal College of Surgeons in England May 2021, https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/ni-waiting-times-may-2021/

[iv] Tallaght University Hospital opens Reeves Day Surgery Centre, December 2020

https://www.tuh.ie/News/Tallaght%20University%20Hospital%20Open%20Reeves%20Day%20Surgery%20Centre%20.html

[v] Sláintecare, a ten-year programme to transform Irish health and social care services. https://www.gov.ie/en/campaigns/slaintecare-implementation-strategy/

[vi] Irish Construction Industry Magazine, June 2021 https://irishconstruction.com/ireland-chapter-of-project-management/ & Ireland Chapter of Project Management Institute, National Awards 2021, https://pmi-ireland.org/categories-national-awards-2021