Reducing the Waiting List for Elective Laparoscopic Cholecystectomy

Gallbladder disease is one of the most prevalent gastrointestinal presentations in the adult population across the developed world. The gold standard procedure for cholecystitis in Ireland is an elective laparoscopic cholecystectomy (LC), which primarily is carried out as an inpatient procedure, with minimal day surgeries being performed. Using the DMAIC (Define, Measure, Analyse, Improve and Control) model for Quality Improvement (QI), this dissertation investigates the waiting times for patients undergoing LC by a single general consultant in a hospital in North Dublin. A variety of tools were utilised including, process flow maps, stakeholder analysis, fishbone diagrams and driver diagrams to identify the root causes of the long waiting lists. The results indicate that the average waiting time for patients is 14.7 months and 100% of these surgeries are carried out as an inpatient procedure. Studies have shown that day surgery LC is a safe and effective alternative when adequate organisation and measures are in place. However, there remains uncertainty in this area with regard to which patients meet the eligibility criteria. Multiple factors influence this eligibility criteria including ASA grade, BMI, co- morbidities and age, but there is no set checklist established and implemented in practice in the Irish Healthcare System. This QI project plan proposes the introduction of an eligibility criteria checklist to identify a patient’s suitability for day surgery, for implementation by a general surgical team. The expected outcome is an increase in the number of day surgeries, with an ultimate long-term goal of decreasing waiting times for patients.