Operating room efficiency in a low resource setting: a pilot study from a large tertiary referral center in Ethiopia

Abstract

Background The operating room (OR) is one of the most expensive areas of a hospital, requiring large capital and recurring investments, and necessitating efficient throughput to reduce costs per patient encounter. On top of increasing costs, inefficient utilization of operating rooms results in prolonged waiting lists, high rate of cancellation, frustration of OR personnel as well as increased anxiety that negatively impacts the health of patients. This problem is magnified in developing countries, where there is a high unmet surgical need. However, no system currently exists to assess operating room utilization in Ethiopia. Methodology A prospective study was conducted over a period of 3 months (May 1 to July 31, 2019) in a tertiary hospital. Surgical case start time, end time, room turnover time, cancellations and reason for cancellation were observed to evaluate the efficiency of eight operating rooms. Results A total of 933 elective procedures were observed during the study period. Of these, 246 were cancelled, yielding a cancellation rate of 35.8%. The most common reasons for cancellation were related to lack of OR time and patient preparation (8.7% and 7.7% respectively). Shortage of facilities (instrument, blood, ICU bed) were causes of cancelation in 7.7%. Start time was delayed in 93.4% (mean 8:56 am ± 52 min) of cases. Last case completion time was early in 47.9% and delayed in 20.6% (mean 2:54 pm ± 156 min). Turnover time was prolonged in 34.5% (mean 25 min ± 49 min). Total operating room utilization ranged from 10.5% to 174%. Operating rooms were underutilized in 42.7% while overutilization was found in 14.6%. Conclusion We found a high cancellation rate, most attributable to late start times leading to delays for the remainder of cases, and lack of preoperative patient preparation. In a setting with a high unmet burden of surgical disease, OR efficiency must be maximized with improved patient evaluation workflows, adequate OR staffing and commitment to punctual start times. We recommend future quality improvement projects focusing on these areas to increase OR efficiency.

Operating room organization and surgical performance: a systematic review

“…This team training could facilitate access to the operating room and reduce unforeseen events and financial losses due to cancellations. In a study about 933 elective procedures, a high cancellation rate was observed primarily due to a lack of operating room time and inadequate patient preparation, emphasizing the need for improved patient evaluation workflows, sufficient operating room staffing, and punctual start times to enhance operating room efficiency in settings with a high unmet burden of surgical disease [ 100 ]. Team learning, involving 40 operating room staff, identified key themes such as a commitment to learning, the significance of a safe space in debriefing, and the role of leadership in mitigating hierarchies [ 101 ].…”

A Randomized Controlled Comparative Study of the Three Over-Bed Techniques for Positioning and Repositioning the Lithotomy Position While Using Stirrups

“… 10 Consequently, their application in clinical context is widespread. 11 Therefore, enhancing the efficiency of the operating room and accelerating turnaround times are essential for maximizing hospital and social benefits. 12 In this study, we aimed to analyze the utilization of three different over-bed methods for the stirrup lithotomy position, adhering to the principles of effective and feasible process development and meticulous control of each step to enhance efficiency.…”

Surgical System Efficiency and Operative Productivity in Public and Private Health Facilities in Ethiopia: A Cross-Sectional Evaluation

“…For example, Samuel et al prospectively studied 933 elective surgeries performed in a tertiary hospital in Ethiopia and found that the elective surgery start time was delayed in 93.40% of cases with a mean start time of 9:41660 minutes. 15 Another study of the performance of 9 ORs in a tertiary teaching hospital in Addis Ababa by Tiruneh et al reported an average delay of 43 minutes from the agreed 8:00 am, and only 2.50% of the operations were started as per the schedule communicated before the surgery. 16 The literature described multiple interrelated factors to explain delays in surgery start time and overall OR productivity.…”

“…A study in Tikur Anbessa Specialized Hospital in Ethiopia, where 35.8% of elective surgeries were canceled, reported that the most common reasons for cancellation were inadequate OR time and lack of patient preparation, 8.70% and 7.70%, respectively. 15 Feleke et al argued that surgical cancellations were primarily due to patient-related and administrative factors, 31.32% and 26.5%, respectively. 24 Dhafar et al retrospectively audited a total of 120 ORs in 25 hospitals in Saudi Arabia and reported that among the 7.60% (1,238 of 16,211) surgeries canceled, the major contributing factors were related to the patient (42.81%), facility (20.03%), and incomplete work-up (9.45%).…”