Efficient perioperative time-management methods for operating theatres: a systematic review showing how to reduce overall patient waiting times for elective surgery

Abstract

Introduction: The effects on long waiting times for elective surgeries from lower operating theatre (OT) performance have been reported in many studies. The timeliness of perioperative processes and adherence to scheduled times is crucial for efficient performance in OT but the perioperative workflow includes multiple tasks assigned to different work teams. Each of these needs to be completed in a timely manner. This systematic review investigates the effects of efficient preoperative systems on the timeliness of upstream and downstream processes in surgical care pathways in order to reduce overall patient waiting times for elective surgery. Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases during December 2019 and January 2020, for articles published after 1 January 2014. All studies pertaining to perioperative time-management methods, which had an intention to reduce waiting times for elective surgery were eligible for this review. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer-related surgeries. Both randomized trials and non-randomized controlled studies were considered and the quality of studies was assessed using ROBINS-I and CASP tools. The review findings are presented as a narrative synthesis due to the heterogeneity of included studies. The PROSPERO registration is CRD42019158455. Results: The electronic search yielded 7543 records and 20 articles were eligible after deduplication and full article screening. There were two experimental studies, five quasi-experimental studies and 13 observational studies. The studies varied widely in design, scope, reported outcomes and overall quality. The first-case-start-time and patient change-over-time at OT were the main time related measures considered as affecting timeliness in many studies. Conclusion: This review suggests that a significant amount of time could be saved with efficient scheduling and planning perioperative processes, which could reduce overall patient waiting time for elective surgeries. Managing perioperative time in isolation could be an enabling factor for an overall increase in both theatre utilisation and theatre efficiency. However, only a small number of good quality studies were available and further evaluation with higher quality study designs and rigour is recommended in order for firm conclusions to be reached.