Examples of what co-design groups achieved

DAY SURGERY
ISSUES INITIALLY RAISED / SOLUTIONS IMPLEMENTED / ADDITIONAL NOTES
Chaotic entry point. / Patients are received in reception and directed to the area where the day surgery nurses are. On arrival patients are introduced and allocated to a specific nurse as their contact point while waiting for surgery.
Separated from relatives/ friends at an early stage. / 30-minute notice period introduced so that patients do not need to leave their relatives until the latest time possible. People can now wait in their own clothes.
Claustrophobic public cubicles separated by a curtain were used as changing rooms and consultation areas. Problems in maintaining patients’ dignity and confidentiality. / A pre-assessment room with examination couch is now available that can be used for consultations with patients instead of a cubicle. Consultants have been informed of the availability of this room, signs have been put up and a timetable for the room developed. A curtain has been added to the consulting room door to ensure privacy.
Continuity of care through day surgery. / Every effort is made in practice to ensure continuity of care through the whole day for patients. Specific nurses are now designated at arrival so that patients and relatives have a point of contact until surgery. There is now a bell to alert the nurses if patients or relatives require further assistance while waiting. After surgery the same nurse gets in touch with relatives or carers and effort is made to ensure that this same nurse also discharges the patient. A board with photos and names of nurses has been created. / It was discussed how ideally it would be good to have the same designated member of staff in the patients’ post-operative care bays as well. However, this could create unequal workloads for staff.
Waiting without being told why or for how long. Patients and relatives knowing what is happening. / Communication between day surgery staff and surgeons has improved so that the day surgery staff can keep patients up-to-date with any changes in theatre lists and the time that they will be taken in for surgery.
The waiting area needs to be separated from seeing where people come out from surgery.
Improve the environment. / Separate male and female pre-op and post-op recovery areas have been created for privacy and dignity.
The physical environment has been enhanced to make it more welcoming.
ISSUES INITIALLY RAISED / SOLUTIONS IMPLEMENTED / ADDITIONAL NOTES
Emotional support during day surgery / Nurses have been trained to deal with the sensitivities of breast cancer. A link nurse was identified who attended a breast cancer study day and then fed this back to other staff. The day surgery audit day also included some teaching around breast cancer. Staff members were taken into theatres so that they could understand the complexity of surgery. Liaison between the breast care nurses and day care staff has developed so that staff members have a better understanding of breast cancer.
Post-operative information in day surgery.
Discharge processes could vary according to different practitioners. / Day surgery staff liaised with the breast clinic to review discharge information and protocols. As a result everybody now has the same information given out.
Information and communication about surgery and different options. Individual needs for information are different.
Could there be a gap between diagnosis and decisions about treatment? / Patient information was reviewed across the whole of the patient pathway in the co-design groups. Essential and optional information was differentiated so that people could choose the appropriate amount of information that they wanted. Patients are now asked individually about the amount of information that they would like. Discussions took place about the implementation of the information prescription. / At the patient event various ideas were discussed including a support group, more time in pre-assessment, an extra appointment before surgery, or a buddy system.
‘Need time to digest information, you can’t absorb it all in at the beginning.’ / The consent process is now less rushed and is begun earlier in the process. People have the information for longer, they can read it at home and then they bring the consent form in on the day of surgery.
It was felt that pre-assessment could be chaotic and that sometimes there were problems with notes. / Information flows from pre-assessments to operating surgeons were fully reviewed. Arrangements for dates of post-operative appointments were changed so that they are arranged with patients prior to their surgery. Patients who have had plastic surgery now all come back to the breast oncology clinic. Patient insights were used to plan the pathway in the simplest and most efficient way.
Post-operative information / Physiotherapy information, the time that it is given to patients in their pathway and the system for arranging patient appointments were reviewed. It was agreed that it was good practice to see patients pre-operatively, which is continuing to be done. Appointments are arranged with all patients post-operatively to ensure all patients are aware of physiotherapy services. / It is important that people do arm exercises after surgery and the idea of a post-operative DVD with exercises was suggested.