From NHS Innovations North West May 2008

Active Management of Critical Care Demand in Major Elective Surgery

The single most common reason for cancellation of major elective surgery is due to the lack of availability of High Dependency Unit (HDU) beds following surgery. The beds may have been used for emergency admissions and other planned admissions requiring post operative critical care. This service aims to actively manage the demand for High Dependency beds following
major elective surgery.

All patients requiring High Dependency Care following planned surgery are referred to the Critical Care Lead, who coordinates the availability of beds to meet these requests. (Surgeons complete a ‘Planned HDU Admission Registration Form’ to request a bed). The need for a High Dependency bed is reviewed by the Active Management Team. Activity is coordinated to ensure all elective surgery is managed in an efficient and equitable way. Prior to the introduction of this service in excess of 25% of planned major surgical procedures in this Trust were cancelled due
to a lack of HDU beds. A national audit in 2003 found that 17% of major vascular surgery was cancelled for this reason.

The introduction of this approach in this Trust has reduced the cancellation rate for major elective surgery to 7.3%. The financial savings due to a reduction in cancelled operating sessions over a 25 month period has been conservatively estimated to be £179,400.

North Cheshire Hospitals NHS Trust