The Impact of 'Golden Local Anaesthetic (GLA)' Principal on Emergency Theatre Efficiency - Analysing 232 Hand and Plastic Trauma Operations

ABSTRACT

Aim: 'Golden local anaesthetic' (GLA) principals are known to improve theatre efficiency. This first GLA case should be suitable to be completed unsupervised by a registrar and confirmed 12 hours prior to the start of the list with a negative COVID PCR test. This allows for list to be started, whilst the consultant is able to see and consent the remainder of the patients for that list, maximising theatre efficiency. Method: Operative timings was gathered in real time in our electronic database (TIMS). Initially, retrospective analysis was performed for cases in November 2020, comparing lists whereby a potential GLA first case was present, versus lists that did not. After remodelling this process, lists in October 2021 were analysed. Statistical analysis was carried out using Mann Whitney U Test. Results: Initially (PDSA-1), 110 trauma cases (58% GA and 42% LA) were performed [3.67/day] whilst post refinement (PDSA-2) 122 cases (52% GA and 48% LA) were performed [3.94 /day]. In PDSA-2, there was a 29% (9/ 31) uptake of GLA list principals. The average GLA list start time was 0927hrs in PDSA-1 and 0908hrs in PDSA-2 [Δ 19 mins, p<0.05] whilst the average non-GLA list start time was worse (0953hrs and 1012hrs). By refining the GLA principal, £470.63 was 'saved' with a further £445.86 potentially able to be saved when starting at the earliest recorded start time (1) Conclusions: The GLA model is a simple and sustainable method to improve theatre efficiency which could be adopted by other units.