Opportunity
PDSA 1: Surgical registrars to choose appropriate timing of ultrasound scan referral to be consistent with the cholecystitis pathway.
Aim
To reduce the time from admission to booking theatre to ≤ 12 hours for Laparoscopic cholecystectomy for those patients with acute uncomplicated cholecystitis. This will help achieve the goal of 48 hours for time from admission to discharge for simple cholecystectomy.
Analysis
The longest time in the patient journey is from admission to booking patient into theatre. The target is 12hrs and data from July 2016 - June 2017 shows this time averages 25hrs. Most of our patients (60%) do not have a diagnostic ultrasound performed within the target timeframe of 12 hours.
Intervention
We focused on radiology constraints on the cholecystitis pathway between admission and diagnosis. Note: The radiology data still needs full validation by the Health Information Group.
Options to test:
- 2 dedicated USS slots for general surgery in the morning Monday to Friday
- USS referral choosing appropriate timing consistent with the cholecystitis pathway
Project Team
Team Member
- Ian Ong, Surgical registrar
- Hannah Collins, Surgical registrar
Project Sponsor
- Richard Harman, Clinical Director of General surgery
Project Lead
- Angie Hakiwai
Project Coach
- Renee Kong
Next Steps
- Validate the data
- Ian and Hannah to complete a literature review of “Ultrasound scan by doctors at the bedside to diagnose cholecystitis” to see if this is feasible to implement locally.
- Conduct PDSA cycle
Ian Ong
Surgical registrar
Hannah Collins
Surgical registrar
Richard Harman
Clinical Director of General surgery
Angie Hakiwai
Project Lead
Renee Kong
Project Coach