Redesigning the general surgery gold patient protocol in a tertiary centre.

BACKGROUND

Emergency theatre capacity is under increasing strain due to rising demand and workforce pressures, contributing to delays and poor compliance with national targets. By prioritising patient selection for low-complexity cases/day-case discharge, we implemented a novel Golden Patient Protocol in a multi-specialty tertiary centre and assessed the impact on surgical wait times and overall theatre flow.

METHOD: The golden patient was agreed upon between surgical/anaesthetic registrars, taking into consideration the urgency/fitness of patient and anaesthetic/technical difficulties. Eligible patients were identified early and scheduled for a huddle and sent for by 08:30. Data were collected over four cycles: 1 month before and after the Golden Patient Protocol introduction, following a 4-month 'cooling-off' (post-Golden Patient Protocol) period and at 24 months, using the trust theatre management system (TMIS). For each patient we obtained 'send time', 'time-in-anaesthetic-room', and 'start-time' aka knife-to-skin.

RESULTS

Across 86 patients (pre-Golden Patient Protocol n = 16; Golden Patient Protocol n = 24; post-Golden Patient Protocol n = 20; 24 months n = 26), median 'time-sent' improved from 08:54 pre-Golden Patient Protocol to 08:28 post-Golden Patient Protocol and remained improved at 08:41 at 24 months (p = 0.013). Median 'time in anaesthetic room' improved from 09:10 to 08:47 and was sustained at 08:58 at 24 months (p = 0.046). Significant pairwise differences persisted between pre-Golden Patient Protocol and both post-Golden Patient Protocol and 24-month cohorts. 'Knife-to-skin' showed a trend towards improvement (09:39 to 09:24; p = 0.244).

CONCLUSION

The Golden Patient Protocol significantly improved early emergency theatre flow for lower-complexity cases while supporting registrar autonomy and reducing delays to first send. Although knife-to-skin improvements were modest, earlier patient preparation and anaesthetic room arrival demonstrated statistically and clinically meaningful gains that were sustained at 24-month follow-up. This low-cost, scalable intervention aligns with Getting It Right First Time priorities and represents a pragmatic strategy to improve emergency theatre efficiency and workflow sustainability.