The intermediate equivalent value outpatient procedure scoring system to maximise the workload of local anaesthetic

Time management of local anaesthetic (IA) outpatient lists is usually via arbitrary methods. The East Yorkshire Plastic Surgery Service covers a wide area to supply daily LA lists for adults. Implementation of government targets requires an ever increasing need to assess and improve the efficiency of care. In this environment it is necessary to ensure that quality of care is maintained and it is not suitable to just book a finite number of cases per list. Methods have to be devised to accurately reflect and assess each surgical procedure to maximise workload. The BUPA Intermediate Equivalent Value (IEV) coding system has assigned a numerical score to graded surgical procedures according to their complexity. This coding system has ‘minor’ and ‘intermediate’ grades both containing procedures undertaken in the outpatient theatre, but each grade is too broad spectrum to analyse outpatient lists. Data was analysed from 482 plastic surgery LA lists to assess these grades and subdivided them into 11 divisions of procedure complexity. The IEV, represented as a numerical score, was calculated for each of these surgical divisions reflecting their complexity and surgical workload (operative time). All outpatient lists can then be constructed according to the actual workload to be undertaken in each operative list and accordingly should enhance list efficiency and maintain quality.