terça-feira, outubro 25, 2005

'French factory' surgeon cuts NHS queues

Jonathon Carr-Brown, Health Correspondent-Sunday Times, 23rd October 2005

A SURGEON in the National Health Service has more than doubled his work rate by introducing a French-style “production line” under which he carries out overlapping operations in different theatres.

John Petri, a consultant orthopaedic surgeon, introduced the system after finding himself frustrated at spending time “drinking tea” while patients were being made ready for operations at his Norfolk hospital.

He operates on one patient while the next is prepared in a second theatre. Petri moves on to the second patient while leaving a junior to finish the first. By the time the second operation is nearing completion, a third patient is waiting for him in the original theatre.

The system enables him to perform as many as five hip and knee replacements in a single shift, compared with one or two typically carried out by surgeons who use one theatre. They have to stop and wait after each operation for the next patient to be prepared.

Petri’s initiative has been welcomed by his hospital managers who believe it could become a model to cut NHS waiting lists. It is being shunned, however, by his colleagues some of whom, he believes, may be deterred by “the sheer hard work” involved in the new system.

Petri, who is Italian and has worked extensively in France, moved to Britain in 1994. “It took me some time to understand how the British system worked but I could not understand why it had waiting lists. When I asked, people would talk about resources. What I saw was that surgeons spent chunks of their time idle waiting to operate,” he said.

“If you were running a factory, you wouldn’t allow your most important and most expensive machine to stand idle. The same is true in a hospital.”

He persuaded his chief executive to carry out a trial of his “dual operating” idea in 2001 and to build a new theatre.

Petri convinced anaesthetists and theatre staff to change the way they worked but was unable to persuade fellow surgeons to join the initiative. He now operates for five hours at a time instead of the standard 3½-hour session.

He uses two anaesthetists so there is always another patient waiting for him and the gap between operations is the five minutes that it takes to scrub himself down. He believes the system has reduced the time he is idle by between 40% and 60%.

Petri has been nominated for the 2005 Medical Futures Innovation Awards by his hospital, the James Paget healthcare trust in Gorleston, Great Yarmouth.

David Hill, chief executive of the trust, said that for a small increase in costs it was now able to treat many more patients. “This won’t work in every speciality but Petri’s approach is leading to discussions throughout the trust,” he said.

“What is important is that clinicians like Petri produce innovative ideas and we demonstrate that they are effective.”

Trial figures show that over 50 operating sessions, Petri performed 270 major and minor operations using the dual theatre system. Two colleagues using the traditional single theatre approach together performed only 225 operations.

Petri can now operate on patients within two weeks of their first consultation. “I don’t drink tea between operations any more. My waiting list is zero,” he said.

Across the NHS similar productivity growth could reduce waiting lists and help the government to meet its 18-week treatment target. At present the 1,530 NHS orthopaedic surgeons each have about 140 patients waiting three to nine months for surgery.

There could be drawbacks for surgeons employing Petri’s methods. As his NHS waiting list has been cut, so the incentive for patients to employ him privately has diminished.

He estimates that his private income has fallen 10% in the past year and he expects it to fall further next year.

Petri said: “I care about my private practice but I care more about people who have no money getting their operation tomorrow and not having to wait a year.”

A survey by the British Medical Association found that one in eight consultants earned at least £100,000 a year from private practice. Anne Moore, of the Royal College of Surgeons, said lack of resources meant “dual operating” was not always viable: “There is nothing to stop surgeons operating Petri’s system. In America surgeons move between as many as 12 theatres but in the UK there are not enough anaesthetists, theatres or other staff to make it work.”