Unscheduled patients: the introduction of a structured booking form to enhance workflow patterns from point of booking until transition to the operating theatre.

Background: The management of unscheduled patients presenting to an operating theatre poses a major obstacle for service planning and provision. The ability to schedule these cases during rostered working hours, where possible, is safer for the patient1 and a more efficient use of theatre, staff and hospital resources2. Aim: The aim of this project was to introduce a structured booking form to enhance workflow patterns from point of booking until transition to the operating theatre for unscheduled patients. Methods: The project was conducted among the theatre staff and stakeholders of a level two hospital in the west of Ireland over a two month between January and February 2014. Focus groups were employed to identify barriers to change. The author employed SWOT and force field anlaysis to determine a strategy for change. A structured booking form was designed for theatre and endoscopy. The change process was delivered using Kotters change model facilitated by action learning sets. Ethical approval was granted to conduct this study. Results: Over the two month period that the study was conducted there was a 52% reduction in procedures performed out of hours for January when compared to the same period the year before. Similarly, there was a 17% reduction for the month of February when compared with same month the year before. Post introduction of the booking form the minimum time taken to schedule an unscheduled patient was 5 minutes and maximum time spent was 7 minutes (a net reduction ranging from 74% – 82.5% in the time taken prior to the introduction of the booking form. If time saved during the booking process was transferred into increased theatre utilisation, this would translate to a potential cost saving ranging between €124,050 – €240,900; assuming every unproductive theatre hour costs €1500 under the productive operating theatre Conclusions: This study has shown that unscheduled patients presenting to theatre can be scheduled in an efficient and effective manner. A structured booking process can translate into considerable cost savings where this results in increased resource utilisation