Background
The Princess of Wales Hospital is a 200 bed DGH in Bridgend serving a population of approximately 160,000 in South Wales. Opened on 11 June 1986, by Diana, the then Princess of Wales, the hospital provides a comprehensive range of in-patient and outpatient facilities — together with Accident and Emergency and specialist services for patients much further afield.
Managed by Cwm Taf Morgannwg University Health Board, the hospital was featured by the BBC earlier in 2023 for its pioneering approaches to elective orthopaedic surgery which were helping to drive down waiting list backlogs caused by the COVID-19 pandemic. In Wales as a whole, the figure for patients waiting for over a year for orthopaedic surgery in August 2023 stood at 37,000.
Approach
In essence, it has been above moving more procedures to a 'day case' approach - not only in the hospital's dedicated Day Surgery Unit, but also in its six Main Theatres.
As ODP in Anaesthetics, Angela Spry, explained: 'While this was the usual practice in our Day Case Unit, it was a change for us in Main Theatres. One of the key benefits is that it removes a shortage of hospital beds as a barrier to patient throughput.
'I think it was the one good thing that came out of the whole COVID pandemic: the way we all came together — Day Surgery and Theatres — and worked together as a team. There is no doubt that we learned from each other, and I think we are seeing advantages from that now.
'While there is always a possibility that patients will have to stay with us overnight after their procedure, it is now the exception rather than the rule.'
Use of Surgical Stretchers
Another aid to patient throughput is the use of surgical stretchers for some procedures rather than fixed operating tables.
This streamlines the flow through theatre because the patient stays on the same platform throughout their journey — from anaesthetic, for the duration of their procedure, and then on into recovery. No time is lost with patient transfers, and there is the added benefit of reduced risk of manual handling injuries to patients and staff alike.
Some of the first procedures to be carried out in this way in Main Theatres were ACL repairs and arthroscopies.
Extending the Procedure 'Basket'
In addition to orthopaedics, theatre teams are also now using the surgical trolleys for gynae procedures, and for paediatric work. In the latter case, a particular benefit is that the stretchers are robust, with a weight capacity that allows for parents to be on the platform as well as they support their children.
Angela also believes they could go further, using the stretchers for general surgeries and other specialisms too. The platforms they are using are Anetic Aid's QA4 Mobile Surgery Systems — and recent years have seen a steady migration to powered versions, which offer electronic positioning, including lateral tilt.
Outcome
The Main Theatres team at Bridgend are now using surgical stretchers for upwards of 60% of procedures and the key has been to ensure that there is a side bar (an optional extra) down the full length of the stretcher, so that it accommodates a wide range of accessories.
They also chose a full width headrest, which gives more surface area for the surgical team to work with.
Said Angela: 'We have had great support from the company too. We see Regional Account Manager Will Barnes and Service Engineer Gareth Humphreys regularly — and Simon Gelder is our contact in the office. Nothing is too much trouble for them - and we know if we have a problem, they will work together to solve it.'
Extra News
In February 2023, the BBC featured the Princess of Wales Hospital and orthopaedic surgeon Mr Keshav Singhal who had introduced key changes to enable joint replacement procedures to be carried out as day cases.
These included 'fine tuning' anaesthetic and pain medication given to patients to reduce pain and nausea after the operation and spending extra time on pinpointing any potential area of bleeding and cauterising it to 'prevent wound leakage'.
He also stressed the importance of reassuring patients about how quickly they can start to move around after their surgery — that it is a benefit, not a risk.
To see the full feature, click here: Bridgend: Surgery changes could halve waiting times - BBC News
To read the full case study, click here: Bridgend Case Study