“Don't get stressed,” said the senior nurse in charge of emergency operating theatres. “I've been here 10 years, and things have always been the same.”
“Let me run this past you again,” I replied, “I am the registrar on call for maxillofacial surgery, and my consultant has a patient with a fractured mandible who needs an operation. The patient has already been waiting 18 hours, and, therefore, his chances of postoperative complications have increased. It is 8 50 am: I am ready to operate, you have nursing staff available, and an anaesthetist is here. However, you are reluctant to send for the patient because general surgery may have a patient to operate on that they told you about last night, but they haven't finished their ward round yet.”
“Well,” said the senior nurse, “the general surgery consultant told me he is only available this morning and wanted to be first on the list.”
The anaesthetist interrupted jokingly, “Your time is not as expensive as his. Anyway we hand over at 9 am, so nothing much will happen for a while. Why not get some breakfast, and we will give you a call when we know what is going on?”
Everyone had been pleasant to me, but the outcome was that no patient was being treated and a lot of NHS time was being wasted, including mine. Frustrated by the inefficiency of the system, I decided not to have breakfast but write a letter to whoever was in charge. After some questioning, I found out that this was the clinical director of anaesthesia, who was part of the theatre users committee.
My letter suggested that each morning at 8 30 am we should have a meeting in theatres between the anaesthetist and senior nurse working in emergency operating theatres and any surgeon who had a patient to operate on in order to prioritise cases. If surgeons were on ward rounds they should delegate one of their team to attend. The first case could then be sent for before 9 am.
Feeling much better, I signed and posted the letter. The next day I showed a copy to a colleague. “You want to be careful, or you will be labelled as a troublemaker,” he advised me.
A week later, I received a reply. Preparing myself for the worst, I read the letter and was delighted to find that my suggestions had been accepted. The anaesthetic handover time was to be brought forward to 8 30 am and my ideas given a trial run. Some four years later the emergency theatre meeting is still going strong.
Many people tell me that in the NHS it is difficult to change things. My reply is always the same: think the problem through, come up with a solution, and then make some polite suggestions to the people in charge. Sometimes, by simply getting involved, it is easier than you think to make a difference.