Identification and Understanding of Utilisation on Different List Types

When THRIVE was built, with its origins in Endoscopy, it was evident that the rooms being tracked and recorded were also being used for other procedures and that there was a specific need to be able to accurately record how many lists and procedures were being used by other disciplines. Recorded initially through notes, we then developed the ability to accurately Tag lists with a variety of core attributes.

Since then, THRIVE’s capacity for sessions to be tagged to identify any list that deviates from the standard has allowed us to subsequently interrogate this unique data to see if there are any identifiable trends that could provide insights and inspire changes in practise to make improvements, maximise efficiency and reduce waiting lists across the NHS. 

There are a host of reasons that a list could have a tag applied; some lists may be planned shorter than the standard, some trusts run trials on different lists so need to identify these when reflecting on their trial data specifically and some trusts have to perform procedures in off-units that can be a significant walk away from the main unit so the tag allows the data to be compared more fairly to those without such a journey.

Tags allow us to take all these potential outliers and view their data sets exclusively, meaning we can identify potential limiting factors to overall unit performance, or see the success of trials of new approaches in their own right.

Making data as valuable as possible to the people that can implement change.

For the rest of this article we’ll be focusing on the below specific list types, as they are some of the most common non-standard service lists to be performed and we have the most data collected so far which allows more significant conclusions to be drawn.

• Anaesthesia
• Bowel Cancer Screening
• Bronchoscopy & Cystoscopy*
• Emergency
• ERCP
• Inpatient List
• Nurse Led List
• Training List

* Bronchoscopy and Cystoscopy refers primarily to Bronchoscopy and Cystoscopy procedures being performed on Endoscopy wards, not all Bronchoscopy and Cystoscopy procedures being performed by providers in the whole hospital.

A NOTE ON POINTS: 

Before we launch into the rest of the content, we should clarify that THRIVE for Endoscopy operates on a ‘point based system’ where a single point is relative to 20 minutes and a List is expected to be planned to an ideal 12 points or 4 hours which is more commonly planned between 9 and 11. THRIVE as a tool can also be used where times and not points are assigned to procedures in a list to accommodate for many more disciplines who don’t use Points for planning.

Points

The THRIVE planned and achieved points for each of these list types is as following (data from between 01.01.2024 and 30.06.2024):

	Planned Points	Achieved Points	List Time
Anaesthesia	10.94	9.85	196m 14s
Bowel Cancer Screening	11.59	11.1	196m 36s
Bronchoscopy	7.86	7.1	145m 48s
Cystoscopy	9.13	8.15	181m 11s
Emergency	6.22	5.53	144m 34s
ERCP	11.18	10.25	192m 32s
Inpatient	9.41	8.45	180m 56s
Nurse Led	10.57	8.95	183m 50s
Training Lists	10.15	8.8	196m 44s

 

A number of these figures are exactly how one might expect them to be. The worst performing list type on these metrics are emergency lists, taking less than 2.5 hours on average within a potential four hour slot. Emergency lists are a necessity at many units, but this often means regularly scheduled slots are being underutilised to account for them by making sure there is always a space for them to take place in. 

The second lowest performer was Bronchoscopy, a respiratory procedure often performed on Endoscopy wards. Endoscopy units rarely get feedback from other disciplines using their rooms meaning being able to monitor performance on these lists can be crucial. Due to the nature of Bronchoscopy, filling lists can be much trickier than Endoscopy lists, leading to shorter lists. Though, now that they are equipped with this knowledge, some units have progressed by setting out more rigid list templates to make sure that a more appropriate amount of time is allocated to Bronchoscopy, based on knowing recent requirements.

Looking at the best performing list types we can see that Bowel Cancer Screening lists and ERCP lists both have the highest planned/achieved points but not necessarily the longest list lengths. These list types are usually done by specialists within their field and contain more complex cases. Thus they have a higher points allocation and often follow strict procedure templates per list.

These procedure templates can be vital in ensuring all lists are planned to maximum capacity, though they do reduce the flexibility of moving patients and procedures from one list to another list within a busy unit with multiple available rooms.

Turnaround Time

The THRIVE average turnaround for each of these list types is as following (data from between 01.01.2024 and 30.06.2024):

	Turnaround Time
Anaesthesia	13m 19s
Bowel Cancer Screening	17m 15s
Bronchoscopy	16m 34s
Cystoscopy	10m 35s
Emergency	15m 26s
ERCP	16m 23s
Inpatient	14m 29s
Nurse Led	10m 34s
Training Lists	12m 21s

 

This reveals that the best performing lists for Planned/Achieved points are amongst the slowest for average turnaround. We briefly mentioned earlier these lists contain much more complex procedures and often patients will require more preparation and information, as well as more detailed write up notes being added to their file following the procedure.

The best performing lists for turnaround time are Cystoscopy lists and Nurse Led Lists. These two list types both primarily feature relatively short procedures, with the vast majority of Cystoscopy lists consisting of either standard or flexible Cystoscopy, both coming in under 15 minutes and the vast majority of nurse-led lists consisting of OGD’s, another sub 15 minute procedure.

This suggests that with these lists, composed of a larger number of shorter procedures, turnarounds can be done more efficiently than on lists with longer or more complex procedures.

Cancellation Rates

The THRIVE average cancellation rates for each of these list types are as following between (data from between 01.01.2024 and 30.06.2024):

	Total Cancellation Rate
Anaesthesia	9.57%
Bowel Cancer Screening	4.63%
Bronchoscopy	9.65%
Cystoscopy	11.33%
Emergency	10.95%
ERCP	10.48%
Inpatient	10.67%
Nurse Led	15.00%
Training Lists	13.73%

 

Once again we see a common theme, here that lists with some of the shortest average procedures have some of the highest cancellation rates.

Perhaps interestingly it’s also worth noting that ERCP’s had the highest rate of Hospital Cancellations, yet Bowel Cancer Screening lists had the lowest rate of Hospital Cancellations and the lowest rate of cancellations total, displaying a major deviation from all other lists and suggesting that perhaps the Bowel Cancer Screening programme has better advanced patient preparation techniques and information that encourages patients to attend and not cancel their appointments. 

All this information can be used to help improve efficiency and subsequently productivity within Endoscopy. Knowing the level of performance that may be lost or gained by planning a specific list type can help to influence the number of these lists being provided by trusts, and can help us to narrow down where efforts must be made to improve routines and templates to reach efficacy.

THRIVE is Inform People’s bespoke product designed in collaboration with the NHS – currently used in Endoscopy departments throughout all of the North West. If you are curious about embracing THRIVE in your own discipline or elsewhere in the UK, please contact us to set up a demonstration via any of our contact options: here.