{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:18:02Z","timestamp":1785525482427,"version":"3.56.0"},"reference-count":14,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Perioperative Practice"],"abstract":"\n Background:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Method:<\/jats:title>\n 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 \u2018cooling-off\u2019 (post-Golden Patient Protocol) period and at 24\u2009months, using the trust theatre management system (TMIS). For each patient we obtained \u2018send time\u2019, \u2018time-in-anaesthetic-room\u2019, and \u2018start-time\u2019 aka knife-to-skin.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Across 86 patients (pre-Golden Patient Protocol\n n<\/jats:italic>\n \u2009=\u200916; Golden Patient Protocol\n n<\/jats:italic>\n \u2009=\u200924; post-Golden Patient Protocol\n n<\/jats:italic>\n \u2009=\u200920; 24\u2009months\n n<\/jats:italic>\n \u2009=\u200926), median \u2018time-sent\u2019 improved from 08:54 pre-Golden Patient Protocol to 08:28 post-Golden Patient Protocol and remained improved at 08:41 at 24\u2009months (\n p<\/jats:italic>\n \u2009=\u20090.013). Median \u2018time in anaesthetic room\u2019 improved from 09:10 to 08:47 and was sustained at 08:58 at 24\u2009months (\n p<\/jats:italic>\n \u2009=\u20090.046). Significant pairwise differences persisted between pre-Golden Patient Protocol and both post-Golden Patient Protocol and 24-month cohorts. \u2018Knife-to-skin\u2019 showed a trend towards improvement (09:39 to 09:24;\n p<\/jats:italic>\n \u2009=\u20090.244).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/17504589261468687","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:18:05Z","timestamp":1785323885000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Redesigning the general surgery gold patient protocol in a tertiary centre"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2646-3062","authenticated-orcid":false,"given":"Sheheryaar","family":"Ahmed","sequence":"first","affiliation":[{"name":"Department of General Surgery, Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabelle","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Peysner","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Ardeshana","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Brocken","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kulbir","family":"Mann","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_3_2_2_1","unstructured":"British Medical Association 2025 An NHS under pressure [online] Available from: https:\/\/www.bma.org.uk\/advice-and-support\/nhs-delivery-and-workforce\/workforce\/medical-staffing-in-the-nhs [Accessed July 2025]"},{"issue":"1","key":"e_1_3_2_3_1","article-title":"Association between timing of operative interventions and mortality in emergency general surgery","volume":"9","author":"David SS","year":"2024","unstructured":"David SS, Liling L, Jamison B, et al 2024 Association between timing of operative interventions and mortality in emergency general surgery Trauma Surgery & Acute Care Open 9 (1) e001479","journal-title":"Trauma Surgery & Acute Care Open"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2013.03.037"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.8145"},{"key":"e_1_3_2_6_1","unstructured":"NHS England 2017 General surgery GIRFT national specialty report [online] Available from: https:\/\/gettingitrightfirsttime.co.uk\/wp-content\/uploads\/2017\/07\/GIRFT-GeneralSurgeryReport-Aug17v1.pdf [Accessed July 2025]"},{"key":"e_1_3_2_7_1","unstructured":"NHS England 2023a Model hospital. 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Emergency laparotomy metrics \u2013 July 2023 Royal Liverpool University Hospital site [online] Available from: https:\/\/model.nhs.uk\/ [Accessed July 2025]"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/14777509231166532"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjquality.u206641.w2670"},{"key":"e_1_3_2_12_1","unstructured":"Royal College of Surgeons of England 2023 Surgical workforce census 2023 [online] Available from: https:\/\/www.rcseng.ac.uk\/news-and-events\/media-centre\/press-releases\/surgical-workforce-census-2023\/ [Accessed July 2025]"},{"issue":"1","key":"e_1_3_2_13_1","article-title":"\u2018Golden Patient\u2019: A quality improvement project aiming to improve trauma theatre efficiency in the Royal Gwent Hospital","volume":"8","author":"Thomas K","year":"2019","unstructured":"Thomas K, Gavin R, Nicola V, et al 2019 \u2018Golden Patient\u2019: A quality improvement project aiming to improve trauma theatre efficiency in the Royal Gwent Hospital BMJ Open Quality 8 (1) e000515","journal-title":"BMJ Open Quality"},{"issue":"9","key":"e_1_3_2_14_1","article-title":"Improving the \u2018Golden Patient\u2019 initiative at a British Major Trauma Centre: A single-centre study","volume":"16","author":"Thompson S","year":"2024","unstructured":"Thompson S, Shahban S, Patil S 2024 Improving the \u2018Golden Patient\u2019 initiative at a British Major Trauma Centre: A single-centre study Cureus 16 (9) e68918","journal-title":"Cureus"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/02688697.2020.1822513"}],"container-title":["Journal of Perioperative Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17504589261468687","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17504589261468687","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17504589261468687","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:48:57Z","timestamp":1785520137000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17504589261468687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":14,"alternative-id":["10.1177\/17504589261468687"],"URL":"https:\/\/doi.org\/10.1177\/17504589261468687","relation":{},"ISSN":["1750-4589","2515-7949"],"issn-type":[{"value":"1750-4589","type":"print"},{"value":"2515-7949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"article-number":"17504589261468687"}}