How time flies: a prospective analysis of theatre efficiency during elective gynaecology lists

Abstract

The aim of this study was to assess the time patients spend at the various stages of the surgical journey and identifying factors that lead to "bottlenecks". A prospective, observational study of 70 patients over 23 consecutive elective gynaecology lists. Timelines of patients' surgical journey were recorded and various outcomes such as room turnover and patient turnaround intervals calculated. Of the 70 patients (23 major and 47 intermediate), 32 were managed by one anaesthetist and 38 cases by two. The mean arrival in the operating theatreknife-to-skin interval for major cases was significantly longer than intermediate (17.9 vs. 12.05 min, p=0.001), but there were no statistically significant differences in other time intervals between major/intermediate cases. The mean patient turnaround and room turnover times for the 70 cases were 44.2 and 60.0 min, respectively, and only 60.3% of theatre time was actually spent on surgery. Having two anaesthetists reduced the arrival in the operating theatreknife-to-skin interval by a mean of 4 min (11.4 vs. 16.63 min, p=0.045) but had no positive effect on other variables. Prolonged patient turnover leads to significant delay, resulting in impaired efficiency. Factors in individual cases which affected patient turnaround time include inadequate preparation of equipment and delays in preparing the patient before anaesthesia. Deploying extra personal at the appropriate time can lead to efficiency savings but adequate planning of both schedules and equipment will lead to the best outcomes.

How Predictable Is the Operative Time of Laparoscopic Surgery for Ovarian Endometrioma?

“…At the same time, efforts should be made in order to minimize the consequences to the patients and optimize resources' usage in other ways. On one hand, patient turnover could be improved by monitoring the time needed by standard perioperative procedures and activities [ 7 , 8 , 20 ]. On the other hand, we should maybe rethink our context where productivity is increasingly measured in number of procedures rather than in health outcomes, particularly in the case of such complex disease.…”

“…Therefore, the usage of the operating theatre (OT) is often under the spotlight of decision-makers [ 6 ]. In spite of evidence that a great proportion of the OT time is lost on nonsurgical activities [ 7 , 8 ], most surgeons have probably felt the pressure to finish a procedure at the planned time, victims of the belief that operative times are predictable. Our need for certainty makes it difficult to question the often wrong but somehow necessary prediction of surgical procedures duration, which is the basis for OT daily planning [ 9 ].…”

Operating theatre efficiency at a tertiary eye hospital in South Africa

“…In our study, we defined start time as the time when the patient is transferred onto the theatre operating bed. Lewis et al [12] found that 91.3% of lists in a UK hospital started late, while locally in SA, Asmal et al [8] found that 74% of lists started late. Asmal et al [8] also defined theatre late starts as lists starting after 08h15.…”