1. Blackpool presentation
SCTS BOR (Ed!) meeting September 2017
Blackpool presentation
Joseph Zacharias

2. The team at Blackpool Success has many fathers… 1:Same day admissions.
2:VATS lobectomy.
3:Finance and coding.
The team at Blackpool

3. Same Day Admissions or Day of Surgery Admission (DOSA)
Initiative in 2010
Cardiac Liaison Ns
Anaesthetists
Surgeons
Oct 2010
60% of all eligible patients
May 2011
Jan 2010
Dec 2015
Nurse Practitioner
20% of all eligible patients
Dec 2010
75% (63/ 84) patients as SDA
Nov 2011
“Every great journey starts with a small step”
Same Day Admissions or Day of Surgery Admission (DOSA)
Timeline

4. Same day admissions Patients are listed for surgery.
Patients are seen by anaesthetist at a pre admission clinic and all blood tests done about 4 to 10 days before op date.
Results are reviewed by a nurse and abnormal tests highlighted to surgeon and anaesthetist
If all okay patient is phoned and told to come at 0730 in the morning
At present 80% of our elective patients are admitted on the morning of surgery

5. Same day admissions Advantages : Patients love it Frees up beds
Reduces cancellations
Possible cost savings!
Reduce overall length of stay

6. Same Day admissions Disadvantages: More work for secretaries
Needs a space for early morning admissions
Beds freed up end up used by other specialities!
Patient makes one extra trip to the hospital

7. Is SDA safe?
All patients who underwent cardiac surgery between June May 2014
Total number of patients- 1210
SDA- 476
Non SDA – 734
Differences in outcomes
Duration of ventilation, Postop stay, blood transfusion, MOF, Mortality
Further Analysis
SDA first patient on list Vs SDA Others
First on list 232, Not first on list 244
Matched Data
Patients who underwent surgery as SDA did not have worse outcomes
There was no difference in outcomes between patients who were first on list and not first on list

8. VATS lobectomy “Good artists copy, great artists steal” Picasso.
Thoracic surgery team

9. Thoracic surgery by Cardio-thoracic surgeons!
First step was to send interested surgeons to a lung cancer MDT
Difficult cases are discussed at a second opinion MDT
VATS lobectomy was offered but sporadically until 2015
Bristol Thoracic surgeons were visited to inspire us.
Thoracic surgeon was funded in 2015 to spend 6 weeks in Copenhagen to bring back ideas
80% of all lobectomies are done by VATS for early stage cancer.
Enhanced recovery with increased input from physiotherapy is expected to reduce length of stay.

11. Finance and Coding Smoke and mirrors Lack of transparency.
What is an operation worth?
When do we make money and when do we lose money?
Coding every procedure and capturing case complexity.
As a national body we need to be mindful that expensive percutaneous options are coming through.