287 A Sigma Six Approach to Improving Nephrostomy and Antegrade Stent Services After a Trust Merger – a Quality Improvement Project

Abstract Introduction As hospitals merge into larger trusts there becomes a centralisation of some services. Urology relies on Interventional Radiology (IR) for Nephrostomy insertions and Anterograde stents in particular. Two lR lists run at Broomfield after centralisation. We aimed to innovate, through improving communication appropriate prioritization patients, ensure patient safety maximum utilisation these lists. Method used sigma six, DMAIC approach. Data was collected over 30-week period. Analysis multifaceted, focused interviews with thematic stakeholder analysis. Value stream maps were created assess waste, fishbone analysis evaluate delayed cases, future state map created, implemented, controlled. Results Prior the intervention, average wait IR 3.66 (n = 74) days above agreed standard 3.5 days. Thematic outlined lack standardisation. Bottlenecks mapping process resulted from communication. The organisational factors, such as rota publishing issues task protocols escalation clarity. intervention standardised proforma, new consultant channel, scan discussions registrar level point escalation. Post showed be 1.22 day staff satisfaction increase 3-fold. Conclusions method proved comprehensive assessment improvement. Patient waiting times can reduced similar experience using methods. Future Plan-Do-Study-Act continually improve once special cause variation has been eliminated – it likely this case.