Summary

Working with NHS England’s Getting it Right First Time (GIRFT) team, Manchester University NHS Foundation Trust undertook a research project to investigate the patient experience and environmental implications of inpatient gallbladder surgeries compared to day case surgeries, and explored opportunities for improvement.

Organisation

Manchester University NHS Foundation Trust (MFT) is one of the largest acute trusts in the UK, employing over 28,700 staff and providing hospital care to 750,000 people across nine hospitals on six sites.

What was the aim/problem?

Gallbladder removal is a very common procedure that’s performed regularly in NHS hospitals and can often be done by keyhole surgery. Although the British Association of Day Surgery recommends that gallbladder removals are performed as day surgeries, a big proportion of gallbladder removals are still done as inpatient procedures, requiring the patient to stay in hospital for at least one night. Working with NHS England’s Getting It Right First Time (GIRFT) team, MFT investigated the environmental impacts of inpatient gallbladder surgeries compared to day cases, the impacts this had on patient experience, and explored opportunities for improvement.

What was the solution?

The Sustainable Healthcare Coalition estimates the average carbon footprint for one patient to stay in hospital for one day is 37.9 kgCO2. Using this figure and anonymised data from all gallbladder removals performed across the NHS in England during 2022, the team at MFT calculated the overall carbon footprint of day case gallbladder removals compared to inpatient cases. They also broke down the data to analyse the environmental impact of both types of gallbladder surgery across all 42 individual ICBs. The team also evaluated their Standard Operating Procedure (SOP) for general surgery to look for areas for improvement and tested a new standardised pathway for surgery day case procedures.

What were the results?

MFT analysed the carbon footprint of 48,000 gallbladder removal surgeries, 66.6% of which were done as day cases. If all NHS trusts increased the proportion of their gallbladder surgeries done as day cases to 71.8% (the highest percentage of gallbladder day surgeries across all trusts), the NHS could save over 189,000 kg of carbon emissions, enough to power 172 homes for a year. Where possible, having their gallbladder procedure done as a day case improved patients’ experience as it reduced the waiting time until their operation and reduced the time they needed to stay in hospital, allowing them to recover in the comfort of their own home.

Evaluation of MFT’s general surgery SOP highlighted the importance of good communication between hospital teams and patients to ensure that clinicians have up to date information. Without this, patients sometimes arrived for day surgery to then be told they would actually need to stay as an inpatient. This often meant that patients had to have their surgery rescheduled to a different day, causing inconvenience and wasting clinical time and resources. To help avoid this problem, the research team worked with clinical leads to come up with clear criteria for which patients should and shouldn’t be considered suitable for day surgery. Making all staff aware of these criteria and adding them to the trust’s general surgery SOP helped to streamline surgery admin and procedure planning, enabling more procedures to take place.

When surgery staff implemented MFT’s new standardised pathway for general surgery, patients flowed through the system more efficiently, helping to improve patient experience, reduce waiting times and save money and carbon emissions. From Oct/Nov 2022 to Jul/Aug 2023, the average number of surgeries in MFT completed in less than four hours increased from 1.2 to 2.6, whilst the percentage of time theatres were utilised for increased from 58.8% to 90.5%.

What were the learning points?

Scrutinising existing pathways can help trusts to identify ways to make services more efficient for patients and improve their overall experience. When appropriate for patients, increasing the proportion of gallbladder removal surgeries that are done as day cases can reduce patient waiting time and chance of readmission, save money and staff time and reduce carbon emissions.

Next steps and sustainability

MFT now plans to share the findings of their study across the NHS to encourage other trusts to take steps to shift from inpatient surgeries to day surgeries where possible.

Want to know more?

To find out more about this project, contact Mr Faraz Ayyaz, National GIRFT Fellow faraz.ayyaz@nhs.net