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.