Time is a terrible thing to waste! Optimising Intraoperative Monitoring Practitioner time to maximise in-house IOM service provision and reduce spend on external IOM service provision

Stuart Lodwick, Grazia Antonacci, Nathan Proudlove

Research output: Contribution to journalArticlepeer-review

Abstract

Intraoperative monitoring (IOM) during orthopaedic and neurosurgical operations informs surgeons about the integrity of patients’ central and peripheral nervous systems. It is provided by IOM practitioners (IOMPs), who are usually neurophysiology healthcare scientists. Increasing awareness of the benefits for patient safety and surgical outcomes, along with post-COVID-19 service recovery, has resulted in a material increase in demand for IOM provision nationally, and particularly at Salford Royal Hospital (SRH), which is a regional specialist neurosciences centre. There is a shortage of IOMPs in the UK National Health Service (NHS). At SRH, this is exacerbated by staff capacity shortage, requiring £202 800 of supplementary private provision in 2022. At SRH, IOMPs work in pairs. Our productive time is wasted by delays to surgical starts beyond our control and by paired working for much of a surgery session. This quality improvement (QI) project set out to release productive time by: calling the second IOMP to theatre only shortly before start time, the other IOMP returning to the office during significant delays, releasing an IOMP from theatre when appropriate and providing a laptop in theatre for other work. We tested and refined these change ideas over two plan–do–study–act improvement cycles. Compared with complete paired working, we increased the time available for additional productive work and breaks from an average of 102 to 314min per operating day, not quite achieving our project target of 360min. The new ways of working we developed are a step towards ability (when staff capacity increases) to test supporting two (simultaneous) operations with three IOMPs (rather than two pairs of IOMPs). Having significantly improved the use of staff time, we then also used our QI project data to make a successful business case for investment in two further IOMP posts with a predicted net saving of £20000 per year along with other associated benefits.

Original languageEnglish
Article numbere002492
Number of pages18
JournalBMJ Open Quality
Volume13
Issue number1
DOIs
Publication statusPublished - 31 Jan 2024

Keywords

  • Delivery of Health Care
  • Hospitals
  • Humans
  • National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division
  • Quality Improvement
  • State Medicine
  • United States

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