Redesigning the general surgery gold patient protocol in a tertiary centre

Area of Science:

• Healthcare Management
• Surgical Workflow Optimization
• Patient Flow Dynamics

Background:

• Emergency theatre capacity faces strain from increased demand and workforce shortages, leading to delays.
• National targets for surgical compliance are often unmet due to these pressures.
• A novel Golden Patient Protocol was implemented in a tertiary center to address these challenges.

Purpose of the Study:

• To assess the impact of the Golden Patient Protocol on surgical wait times.
• To evaluate improvements in overall emergency theatre flow.
• To determine the sustainability of the protocol's effects over time.

Main Methods:

• The Golden Patient Protocol involved prioritizing low-complexity cases for early scheduling, determined by surgical/anaesthetic registrars.
• Data on 'send time', 'time-in-anaesthetic-room', and 'knife-to-skin' were collected over four cycles: pre-protocol, post-protocol, and at 24 months.
• The trust theatre management system (TMIS) was utilized for data collection.

Main Results:

• Median 'time-sent' improved significantly from 08:54 pre-protocol to 08:28 post-protocol, sustained at 08:41 at 24 months (p=0.013).
• Median 'time in anaesthetic room' improved from 09:10 to 08:47, sustained at 08:58 at 24 months (p=0.046).
• 'Knife-to-skin' showed a trend towards improvement (09:39 to 09:24; p=0.244).

Conclusions:

• The Golden Patient Protocol significantly enhanced early emergency theatre flow for lower-complexity cases.
• The protocol supported registrar autonomy and reduced delays to first surgical case.
• This low-cost, scalable intervention offers a pragmatic strategy for improving emergency theatre efficiency and workflow sustainability.