Facilities and resources
In 51 out of 100 reviews, an aspect of the facilities and resources available needed further attention. Areas where specific problems occurred were:
- Lack of availability of surgical ward beds and/or the ability to ring fence beds for elective procedures.
- Managing acute admissions.
- Having properly timetabled access to appropriate operating theatres for elective and emergency surgical care.
- Getting access to sufficiently well-staffed, specialist, high-dependency and intensive care units.
- Ensuring that hospital facilities have been appropriately designed for the surgery undertaken (for example to support day case surgery, or enhanced recovery).
- Having appropriate instrumentation available and suitable processes for sterilisation and/or maintenance of instruments.
- Problems with processes for the design and review of surgical job plans.
- Access to appropriate and functioning hospital computer systems supporting the delivery of surgical care.
- The number and skill-mix of nursing staff supporting surgical services.
- A service’s capacity to recruit consultant surgeons and other medical personnel.
- The administrative staff available to support the running of the service.
- Appropriate access to the expertise provided by other healthcare professionals, such as clinical nurse specialists or specialist physiotherapy.
Addressing concerns about facilities and resources before problems occur
Hospital personnel are often aware of the shortcomings of their working environment for a long time. They have suggestions for improvement but are not in a position where they can put these into practice. Without careful attention, facilities and resources can significantly reduce the quality of surgical care. Staff should be supported to ensure that their suggestions for improvement are implemented. There should be particular vigilance against passively accepting a situation that is unsatisfactory and then unsafe.