Introduction Introduction: The three session day (8.30–20.30) was implemented at the Royal Liverpool Hospital (RLH) October 2009; this was necessary to guarantee an increased capacity in order to meet current and predicted service needs to accommodate the increase in activity lower GI investigation including the bowel cancer screening programme (BCSP) and rise in complex endoscopy
Methods Aim This is a reflective look on how this programme of change was implemented, what was achieved by its implementation and what lessons have been learned through the process.
Results Prior to implementation 4 rooms were undertaking 12,000 procedures per year with 40% inpatients 60% day-case activity. Waiting times were urgents2–5 wks, routine 8–9 weeks, and surveillance 19 weeks
Workforce planning and implementation A collaborative approach between Trust (business case approval), Consultants, Nurse Managers, Administration and Human Resources and nursing unions was necessary to ensure full staff engagement as shift patterns had to be changed; job plans and contracts had to be altered. The increased workload required a long term investment of; 3X WTE Consultant Endoscopists (6 lists each), 1 X WTE Nurse Endoscopist (for training and 6 lists),10X WTE Nurses/HCAs, 1X WTE Admin Manager, 2 X WTE Admin staff, 1XWTE Medical secretary. 1xWTE Nurse Educator, 1 WTE: Unit Manager
List scheduling 3 rooms are simultaneously run in the evening; these are segmented into 1 upper, 1 colonoscopy and 1 in-patient list. The day-case lists are shorter at 3 hours; so either 4 colons, 10 OGDs, 4 EUS or 6 in-patients are schedule per list. No complex endoscopy is listed. Patients listed have been younger with less co-morbidity thus reflecting the working population. Particular advantage for colonoscopy as all bowel prep can be taken on the day of procedure.
Results Activity has increased to 16,000 procedures per annum with > 85% being day-case. This is due to a work-force flexibility and continual stream of communication through the admin manager to achieve list utilisation > 95%. With full booking, DNA in evening is < 5%. In our patient survey, 85% reported that they do not mind, are willing or very willing to come in the evening list. Waiting times; all urgent are within 2 weeks, routine within 6 weeks and Surveillance within 6 weeks.
Conclusion 3 session day can improve capacity and reduce waiting times but needs workforce planning and significant capital investment. It requires leadership, workforce and skill mix review, workforce flexibility and a dedicated team.
Disclosure of Interest None Declared.
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