C. Oakley, S. Farrell, G. Duignan

HSE Ireland, Sligo, Ireland


In the post pandemic era of care prolonged waiting lists are common and it was found a significant number of children were waiting for grommets in our region. Grommet insertion is a short procedure that requires general anaesthesia but has a meaningful impact on hearing and speech in young children. Timely intervention is beneficial.


Prior to project BOOST only 1-2 paediatric patients per week had this surgery as lists are mixed with adult patients. By creating these focused lists we provide streamlined theatre flow without compromising quality of care.

Strategy for change

Using our national Health Services Executive (HSE) quality improvement toolkit our aim was to develop focused sessions in ENT theatre every 4-6 weeks until the waiting list is cleared. We used the SMART format to identify our aims.

S – Target population:  ASA 1 children assessed to require grommets aged 1-4

M – Measurement: reduction in waiting list size

A – Well organised theatre flow with input from all stakeholders in the perioperative process.

RT – Timeframe initially 6 months, then review.

An educational programme consisting of lectures and “skills and drills” sessions were held prior to BOOST lists aimed at familiarising theatre staff with common paediatric perioperative complications.

A standardised anaesthetic was provided by a consultant anaesthetist, with an interest in paediatric anaesthesia, and two registrars to allow for quick case turnover and immediate assistance for recovery staff when required.

Measure of improvement:

The primary outcome measure of project BOOST was waiting list reduction within the 6 months. Secondary outcome measures included staff satisfaction surveys in regards to experience on the day and pre-list educational sessions as well as incidence of adverse events such as laryngospasm and post-operative delirium.

A PDSA cycle was completed after each BOOST list with lessons from each cycle actioned for the next.




Lessons learnt:

  • The first PDSA cycle highlighted areas for action including adherence to fasting times and a sip till send policy was introduced. We also identified the need for surgical and anaesthetic pre-assessment to assess if grommets were still required and ASA scores.
  • PDSA cycle two showed it was possible to extend the BOOST list to also include grommets and adenoids.
  • Our theatre department can provide a quick turn around paediatric list with no compromise on patient safety while significantly reducing the waiting list by continuous evaluation of both the indication(surgeons) and the process.
  • PDSA cycle three is ongoing.

Message for others:

It is possible to provide tailored BOOST lists aimed at delivering a standardised anaesthetic approach to a homogenous selection of patients for a specific procedure with good outcomes. This also allows anaesthetists with special interest areas to upkeep their skills, providing educational opportunities for all.

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