Improving Theater Turnaround Time

Having started off my career as registered midwife, I did undertake other nursing trainings (peri-operative, Bachelor of Science in nursing trainings) which so far have culminated in my rise to the position of an Assistant Director, Nursing services and head of units/supervisor of all the theatres/CSSU in National Hospital Abuja, Nigeria.

My responsibilities involve the supervision of all units’ activities, organizing and arranging for the continuous professional training of the nurses, participation in the promotion of the patient focused approach to care especially with the Smile Train program on cleft lip/palate repairs, nutrition etc. It also involves co-coordinating the activities of the medical /surgical team members to enhance efficient service delivery in the OR, ICU and CSSU. I also contribute to research and development programs, ensuring the maintenance of best clinical standard for sterility of equipments and work place. I participate and initiate the formulation of nursing policies.

Out of the number of booked elective cases (usually 4-6) only 2-3 gets completed in a day despite having 4 fully functioning operating suites. This led to about 37 cases being cancelled or rescheduled in a month. In addition, staff apathy and not taking responsibility of cases were all factors contributing to the above problem

Therefore, it was urgent to meet the needs of the patients satisfactorily and building up a team that are self motivated to ensure that high quality patient focused care is maintained at all times. Thus, “improving theatre turnaround time”

Since implementing the interventions and structures, there has been an improved rate of surgeries per month. This decreased the rate of cancelled surgeries from 37 to 7 per month creating a lasting positive impact where helpless patients/parents on the list of backlogs, due to previous or frequent cancellation of cases now have their surgeries being undertaken. 

Out of the number of booked elective cases (usually 4-6); only 2-3 gets completed in a day considering the 4 operating suites that we have. This leads to about 37 cases being cancelled in a month

There was staff apathy leading to many not taking responsibility of cases and assignments which were all factors contributing to the problems. Also, there was frequent late coming and cases of non-accountability

Having series of meetings/dialogues organized for the health professionals who had apathy over rendering services. This is in order to meet their motivational needs. Sharing responsibilities among staff and requiring a daily report of events submitted.

Being part of the work force and actively participating in activities myself (scrubbing, circulation in the OR during surgery). There is also strict supervision of all staff, counseling and reassuring patients/relatives.  Working with the medical team to create more slots and surgery days 

Providing adequate consumables and sharing responsibilities to all team members

Monitoring and supervising to evaluate the theatre turnaround time in-between patients

This project seeks to impact the helpless patients/parents on the list of backlog, due to previous or frequent cancellation of cases. The cleft lip/palate patients, other surgical patients

We understand their needs through counseling and oral interviews with patients /relatives on how services can be enhanced to improved their experience.  Also, maintaining an open door policy for suggestions from staff and patient/relative.

The project addresses their needs by working with the medical team to create more slots and surgery days by doing so, improving the theatre turnaround time and accommodating more clients

Elevating understanding between the healthcare workers (doctors and nurses) my project would help change their attitude/mindset as they now staff now take responsibility to care for specific patients needs.

With the implementation of my intervention, staff stopped being nonchalant. This by extension accommodated patients in the backlog list of surgeries

Prior to my tenure as the head of units of the theatres, the theatres were improperly managed leading to loss of equipment many of which were unaccounted for. In the midst of these, I stood out in my ways of heading the labour theatre. There were no feotal and maternal mortality, manpower management and organization was good and availability of consumables was adequate through a functional revolving fund.

Therefore, I was appointed to head and supervise all theatres leading to me setting unique priorities like:

To facilitate change in staff attitude to work

Institute discipline in handling issues

Set out adequate regulations (resumption time, accountability, introduction of routine inventory check)

Routine check and monitoring of equipment, instruments, consumables etc

Strict taking over and handing over processes

Routine series of meetings involving all the theatre users to share ideas and sort out issues Having incentives given to staff that performs well in their duties  

To stand out differently because I love my job. I want to make a difference and I love standardized functional systems as I believe that these would help my team and I render adequate care and thus have a positive impact in the lives of others  

With the Smile Train program coming to Nigeria, it brought with it hope for many African families and making the theatres function efficiently becomes an important aspect of the program.

In addition, making it possible and convenient for patients and relatives to have a pleasant theatre experience and leave smiling is the most rewarding of everything else.

I am a trained midwife and peri-operative nurse who have worked in both the rural and urban setting with mothers and children. Subsequently, I have continuously developed myself academically with my growing professional experience and by this grown progressively in my career to become an Assistant Director Nursing Services.

Therefore as a professional in the management position, I have access to formulate, initiate and execute policies. I also train and examine both nursing and medical staff. Presently I am a member of the committee that structured the “KIDS OR” an operating theater where the cleft lip/palate surgeries are done

At a time when there was inadequate availability of consumables to perform surgeries leading to delays and postponement of procedures. I presented a memo suggesting the institution of a revolving fund to run the labour ward and labour theatre.

This was accepted, approved and commenced leading to improved availability of consumables and in turn zero foetal/maternal mortality.

Again, before assuming headship of the theatres there was a state of no accountability leading loss of numerous hospital equipment/instruments. However, upon my assumption as unit head, I introduced a system of inventory and record keeping which makes staff accountable and responsible for assigned equipment thus leading to a halt in loss of equipment so far.

The first successful conjoined twins separation in Nigeria was performed by in my hospital in November 2019, I coordinated the surgery. There were five specialties (Paediatric surgery team, Thoracic surgery team, Plastic surgery team, Nursing team and Anaesthetic team) and other auxiliary staff.

Every team performed their function with surgical precision and taking over was seamless and without hitch because they all observes the regulations set by the theatre (silence, stealth, positioning, operation of equipment). There was need for utmost control in order to achieve 100% infection free case.

I was chosen by these teams to coordinate this surgery in order to achieve this success and to execute all the regulations stipulated by the program

The Hospital is designed to cater for the needs of the Nigeria population as well as the West African sub-region with a view to reduce morbidity and mortality rates, and to carry out extensive research into the peculiar causes  diseases in Africa.

However, in order for the vast majority of Nigerians to benefit from the services and modern equipment in the Hospital, the scope of its operation spans to cater for every Nigerian despite the economic status. 

Inline with the policy of efficiency, my project is in conformity with the values of my institution.

It changed peoples attitude.

The current number of people serve through my project--60

The number in one year- 725

The number in five years- 3510.

My goals give smiles to as many children as possible.

Reduce as much as possible the number of children having cleft lip/palate conditions.

Train and mentor more doctors,nurses and health care workers to continue the care as it affect humanity.

Sponsorship for training more people to help create awareness.

Replacement of broken instruments/equipment's.

I  will seek for support from international organizations to sponsor training.

At the same time  ask for replacement of equipment and instruments.

I am partnering with Smile Train.

Smile Train offers free cleft surgery.

Smile Train offer training to medical cleft team members - Nurses, Anesthetist, surgeons.

Replacement of obsolete and broken instruments and equipment.

More educational training, capacity building. 

With funding and revenue, I will be able to send more people for training and pay for their expenses,[accommodation, transportation, feeding,materials for training]

With mentor ship and coaching, I will be able to have people that will move the scope of care to more communities.