Operating efficiency of an emergency Burns theatre: An eight month analysis

Mohan, Arvind; Lutterodt, C.; Leon-Villapalos, Jorge

doi:10.1016/j.burns.2017.04.023

Cited by 4 publications

(6 citation statements)

References 12 publications

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“…2,[4][5][6] Other aspects which contribute to theatre delays include patient factors, technical/equipment issues, and scheduling and transport factors. 1,2,5,[7][8][9][10] Poor communication, teamwork and punctuality (attributed to the surgeon, anaesthetist, nursing or other theatre staff) may have a cumulative effect on perioperative delays and theatre inefficiency. 1,5,8,11 Despite the recognised importance of staff activities on theatre efficiency, limited research exists characterising the time points associated with them.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,5,[7][8][9][10] Poor communication, teamwork and punctuality (attributed to the surgeon, anaesthetist, nursing or other theatre staff) may have a cumulative effect on perioperative delays and theatre inefficiency. 1,5,8,11 Despite the recognised importance of staff activities on theatre efficiency, limited research exists characterising the time points associated with them. Instead, studies often focus on patient time points and changeover metrics, such as turnover time between cases, theatre utilisation rates and first case on time starts to assess operating theatre efficiency.…”

Section: Introductionmentioning

confidence: 99%

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Assessing operating theatre efficiency: a prospective cohort study to identify intervention targets to improve efficiency

Wallace

Muir

Romano

et al. 2021

ANZ Journal of Surgery

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Background: Operating theatre efficiency is critical to providing optimum healthcare and maintaining the financial success of a hospital. This study aims to assess theatre efficiency, with a focus on staff activities, theatre utilisation and case changeover. Methods: Theatre efficiency data were collected prospectively at a single centre in metropolitan Melbourne, Australia, over two 5-week periods. Characteristics of each case and various time points were collected, corresponding to either in-theatre staff activities or patient events. Results: Two hundred and ninety-nine cases were prospectively audited over a range of surgical specialties. Setting up represented 42.4% (37.28 min), operating time 40.1% (35.28 min) and finishing up time 17.5% (15.43 min). Theatres were empty (turnover time) for 17.42 min, which was 39.4% of the non-operative time between operations (44.25 min, turnaround time). Plastic surgery operations required the shortest set-up and finishing times on most of the measured metrics, with general surgery and obstetrics/gynaecology having longer times. List order made a significant difference, with efficiency improving over the list and over the day for separate am and pm lists. When a patient was not on time to theatre, efficiency in both set up and finishing up metrics was significantly worse. Conclusions: A large proportion of theatre time was being spent on non-operative tasks, making staff activities potential targets for operating theatre improvement interventions. Motivation and team familiarity were identified as the major factors behind efficiently run operating theatres, supporting the use of regular operating teams and maintenance of a highly motivated workforce.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessing operating theatre efficiency: a prospective cohort study to identify intervention targets to improve efficiency

Wallace

Muir

Romano

et al. 2021

ANZ Journal of Surgery

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“…6 Late start times are a common reason for operative time lost on the trauma or emergency list across all surgical specialities. 7 A delay of 1 hour at the start of the trauma list is estimated to cost a trust around £1400. 8 While reasons for delays are multifactorial, clarity of list order at the trauma meeting is a significant contributing factor.…”

Section: Introductionmentioning

confidence: 99%

Improving the quality of trauma meetings by implementation of a modern trauma management platform

et al. 2020

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Trauma meetings constitute the majority of clinical decision-making for new referrals and also act as a crucial tool to coordinate the trauma theatre list. Incorporation of electronic technology has been shown to improve the quality of patient handover. eTrauma is a recently developed cloud-based patient management platform which we planned to implement at our hospital. The aim of our project was to evaluate the quality of our current trauma meeting and subsequently the effect of implementing a modern trauma management platform. In order to identify the key concerns of staff members with the trauma meeting handover, a questionnaire was given to 20 members of the team. A review of effective handover guidelines published from the Royal College of Surgeons and the Royal College of Physicians was undertaken. We combined information from these guidelines to identify two key sets of data points for an effective trauma referral: patient demographics and referral details. Questionnaires were distributed at three separate time periods providing assessment of implementation of changes. The questionnaire results indicated progressive improvement in the morning trauma meeting with increased clarity for the anaesthetic team, better communication of operation to be performed, better documentation and clarity of management plans. A total of 150 referrals using the existing system (TIGER) were compared with 100 eTrauma referrals at two separate time intervals. Our analysis showed significant improvements in 12 (57%) of the 21 key data points indicating improved data entry for referrals using the new platform. Three PDSA (Plan, Do, Study, Act) cycles were completed with relevant adjustments within this process. Introduction of a new cloud-based trauma management platform has had a positive impact overall within our trust. Modern electronic trauma systems have the ability to improve our trauma management, this must go hand in hand, however, with a structured and effectively communicated trauma meeting.

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“…Increasing trauma theatre efficiency is important for improving patient outcomes and for a National Health Service under increasing economic restraints. Late start times are a recognised problem for emergency lists across the surgical specialties 4. Factors that have demonstrated an improvement in theatre efficiency include direct consultant supervision, improved communication within the theatre team and financial incentives 4–6.…”

Section: Introductionmentioning

confidence: 99%

“…Late start times are a recognised problem for emergency lists across the surgical specialties 4. Factors that have demonstrated an improvement in theatre efficiency include direct consultant supervision, improved communication within the theatre team and financial incentives 4–6. One technique proven to improve list start times is the selection of a predetermined first patient 7–9.…”

Section: Introductionmentioning

confidence: 99%

‘Golden Patient’: A quality improvement project aiming to improve trauma theatre efficiency in the Royal Gwent Hospital

et al. 2019

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The efficiency of trauma lists when compared with elective orthopaedic lists is a frustration of many orthopaedic departments. At the Royal Gwent Hospital, late start times affecting total operating capacity of the trauma list were recognised as a problem within the department. The design team aimed to improve the start time of the list with the introduction of the ‘golden patient’ initiative. A protocol was agreed between the orthopaedic, anaesthetic and theatre staff where a ‘golden patient’ was selected for preoperative anaesthetic assessment by 14:00 the day before surgery and sent for at 08:15 as the first case on the trauma list. Baseline data was collected over a month. Two Plan-Do-Study-Act (PDSA) cycles were completed, one on the month the ‘golden patient’ initiative was implemented and one 4 months after the change. All data was collected from the Operating Room Management Information Service theatre system for the trauma theatre at the Royal Gwent Hospital. Results demonstrated significant improvement in patient arrival time in the theatre suite; PDSA1 by 33 min (p≤0.001) and PDSA2 by 29 min (p≤0.001) and an earlier start of the first procedure; PDSA1 by 19 min (p=0.018) and PDSA2 by 26 min (p≤0.001). There was also increased mean operating time per list (PDSA1 +16 min and PDSA2 +33 min), increased total case number (PDSA1 +20 cases and PDSA2 +36 cases) and reduced cancellations (PDSA1 −2 cases and PDSA −5 cases) compared with our baseline data. We demonstrated that the introduction of a ‘golden patient’ to the trauma theatre list improved the start time and overall operating capacity for the trauma list. Continuing this project, we plan to introduce assessment of all patients with fractured neck of femur in a similar way to the ‘golden patient’ to continue improving trauma theatre efficiency and reduce case cancellations.

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Operating efficiency of an emergency Burns theatre: An eight month analysis

Cited by 4 publications

References 12 publications

Assessing operating theatre efficiency: a prospective cohort study to identify intervention targets to improve efficiency

Assessing operating theatre efficiency: a prospective cohort study to identify intervention targets to improve efficiency

Improving the quality of trauma meetings by implementation of a modern trauma management platform

‘Golden Patient’: A quality improvement project aiming to improve trauma theatre efficiency in the Royal Gwent Hospital

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