NHS staff find innovative way to tackle surgery waiting lists

Guy’s and St Thomas’ is using high intensity theatre lists – known as HIT lists – to help reduce the backlog for non-emergency surgery caused by the pandemic.

Staff have been looking into innovative ways to tackle the waiting list for routine operations and procedures, and have developed a super-efficient but safe programme to maximise the number of patients treated in one day. 

The HIT lists focus on one type of procedure at a time, and take place at weekends. They require careful planning to select suitable patients – and in most cases have been able to treat at least three times the number of patients compared to a regular surgical list.

So far the Trust has held 11 HIT lists and treated 240 patients across a range of specialities, including gastrointestinal, gynaecology, orthopaedics and ear nose and throat (ENT).

The innovation and organisation of the HIT lists has been led by Dr Imran Ahmad, consultant anaesthetist and deputy clinical director for anaesthesia and theatres.

Dr Ahmad said: “For many surgical procedures, the time required to perform the actual surgery is significantly less than the time spent preparing and anaesthetising the patient, setting up the equipment and helping the patient to recover – in some cases the operating time can be as little as 30% of the duration of the whole operating list. 

“We have looked at every aspect of the patient’s pathway in detail to see where we can safely improve on efficiency, save time and parallel process in order to increase the surgeon’s operating time, by reducing non-operative time. It requires a dedicated multidisciplinary team and lots of preparation, which is the key to our success. It’s a bit like a Formula 1 pit stop crew where you have people who are all well trained and work together to do something very efficiently and safely.”

The HIT lists involve:

• Increasing the number of anaesthetic, surgical and theatre staff in order to minimise the turnaround time between cases, making more time available for the surgeon to operate. In some cases this has been over 95% of the day
• Using two theatres and three teams, the surgeon can go between cases without having to wait for the patient – this allows for many more cases to be done in the same time period
• Several multidisciplinary meetings led by Dr Ahmad are required for each HIT list to select suitable cases, patients and team members and to plan the equipment and order of the lists – they include managers, administration staff, therapists, nurses, pharmacists, anaesthetists and surgeons.

The most recent HIT list at St Thomas’ Hospital saw 17 patients treated for hernia repairs instead of 5.

Lorena Gonzalez, a speech and language therapist for the NHS, was one of the patients who benefited. The 42-year-old said: “I knew I would need to have an operation after my third baby, but I was quite surprised when I was contacted about scheduling my procedure, as I was expecting it to take a lot longer.”

Lorena, from Southwark in south London, added: “On the day of my surgery everything happened very quickly and everyone knew what they were doing. From the health support workers and nurses to the surgeons and anaesthetists, everyone was on the ball and it felt like a well-oiled process. I didn’t feel rushed at all and I would definitely recommend it to other patients.”

Mr Husam Ebied, a consultant general surgeon who carried out the hernia repair HIT list, said: “The COVID-19 pandemic has inevitably had a knock-on effect on non-urgent care, but our incredible staff are pulling together to get the waiting lists down. The HIT lists require meticulous planning, very careful case selection, close teamwork and excellent communication between the multidisciplinary teams in order to ensure that patient safety remains the top priority and that there is no increased risk of complications.”

Lidia Gonzalez, from Bermondsey in south London, had been in chronic pain following a car accident in 2014. She had a hip replacement as part of the HIT list at Guy’s Hospital in August 2021, which saw 12 hip replacements take place instead of 4.

The 49-year-old, who used to compete in body building competitions, said: “The pain got progressively worse during lockdown and I was devastated when I found out how long the waiting list for surgery could be. It’s absolutely phenomenal that the HIT list is an option for people who are relatively fit and well. The care from start to finish was excellent.”

She added: “I’m getting my quality of life back and feel like a weight has been lifted – it’s a wonderful feeling to not be in pain every single day. My recovery has been going super well and I even did a cartwheel the other day. I’m back to deadlifting and squatting and can run for 20 minutes – something I haven’t done in three years.”