Surgical team carries out ‘high intensity’ adenotonsillectomy surgery day to tackle backlog

A surgical team at Medway Maritime Hospital has removed more tonsils and adenoids of some of its youngest patients in a single day than ever before using an efficient and safe programme to help cut waiting times.

The ear, nose and throat (ENT) surgical team operated on 10 children on the same day earlier this month (October), double the usual daily number, with eight of the children having both their tonsils and adenoids removed at the same time, as part of a High Intensity Theatre (HIT) list.

Ear, Nose and Throat (ENT) Consultant David Pennell, who led the project, worked with the ENT Clinical Lead and operations team to devise the hospital’s first adenotonsillectomy HIT list. The department was inspired by a Getting It Right First Time (GIRFT) publication about TonKIDZ, a project by Barking, Havering and Redbridge University Hospitals Trust, carrying out 100 tonsillectomies in a single week.

HIT lists are designed to safely reduce the backlog for non-emergency surgery caused by the pandemic by focusing on just one type of routine surgical procedure and minimising surgeon down-time so they can operate on more patients. In order to do this, all HIT lists need careful planning, bringing together managers, administration staff, nurses, anaesthetists and surgeons, plus other clinical staff, to select suitable patients, plan the order in which they are seen, and arrange all the equipment needed.

Mr Pennell said: “ENT surgery, particularly tonsillectomies, make up the bulk of our paediatric waiting list, but to carry out a HIT list to help reduce the number of children waiting to have their tonsils removed, requires cohesive thinking and team work. After talking to the nurses, admissions staff, surgical teams and anaesthetic colleagues, everyone was on board to deliver excellence for our patients.”

The approach was to minimise the surgeon’s down-time, moving efficiently from patient to patient, enabled by an experienced theatre team and a standardised anaesthetic, led by Dr Samantha Black, Paediatric Anaesthetic Lead.

Mr Pennell added: “We had one team operating on a patient while the other team was getting the next child ready for their anaesthetic. To ensure no theatre time was lost, we also had back-up patients lined up in case there were any cancellations, which required the support of parents. Each patient was contacted before the day of surgery to ensure they had read up to date advice leaflets on the procedures and to prepare them for their general anaesthetic.

The success was coupled with the fact that there is now a dedicated children’s ward within Medway Maritime Hospital’s Sunderland Day Care Unit for children to recover following the procedure. This not only means a better experience for children and their families but also a better use of theatre time.

All of the children went home the same day following observation.

Feedback, which was submitted anonymously through the Trust’s Friends and Family Test (FFT), by parents and carers of the children who underwent the procedure, included:

• “Everything was perfect.”
• “Timely and very quick. Everyone is friendly and kind and caring.”
• “Staff were well presented and good atmosphere. Staff have gone above and beyond for us.”

Jayne Black, Chief Executive of Medway NHS Foundation Trust which operates the Gillingham-based hospital, said: “This is a fantastic example of excellent team work to treat more of our patients sooner.

“Thanks to everyone’s efforts our waiting list for tonsillectomies is reducing, and with the team planning to host future HIT lists for this procedure, the backlog for will be cleared sooner. This is great news for our young patients as having their tonsils removed can make a big difference to their quality of life.”