Aims Over time, demand for paediatric intensive care beds is rising inexorably.1 Most units, operating close to capacity, balance the needs of planned admissions with emergencies. Following cardiothoracic surgery, most children require a period of intensive care. Unplanned admissions may mean a bed is not available and in these cases the operation is often cancelled at short notice, causing significant distress for patients and families. In our institution, ongoing audit showed that around 6 operations were cancelled on the day every month due to lack of capacity in cardiac intensive care. Our aim was to reduce this number by 30%.
Methods Following observation and process mapping, the daily planning meeting for staff members from cardiothoracic wards and sub-specialities was selected as the setting for the initial intervention. The primary outcome measure was numbers of, and reasons for, same-day cardiac surgery cancellations and was plotted on a SPC (statistical process control) chart.
Results A system of creating a list of all potential admissions (elective and emergency) on a board at the meeting was developed and refined through several Plan-Do-Study-Act (PDSA) cycles. For the four months after the new system was introduced, the number of patients cancelled on the day of operation due to capacity in cardiac intensive care was reduced to a mean of 2.2 per month from 6.1 at baseline (65% reduction).
Conclusion Even in the most complex systems, a straightforward low cost idea can deliver a measurable improvement. This simple change created a shared visual resource, promoting more effective multidisciplinary communication and discussion and allowed better balancing of elective and emergency admissions according to priority. When bed availability for the following day was threatened, this information sharing enabled the team either to make alternative arrangements to allow surgery to proceed, or at worst re-book with more notice. As a result, same-day cancellations of cardiac surgery were reduced by almost two thirds allowing the department to better predict their case-load and improving the experience for children and families.
Paediatric Intensive Care Audit Network Annual Report 2010–2012 (published September 2013): Universities of Leeds and Leicester.