Audit of operating theatre time utilization in neurosurgery

Abstract

Utilization of operating theatre time is an important issue in neurosurgery, in a National Health Service Hospital. NHS Trusts are under ever increasing pressure to meet specified 'targets' in relation to admissions and operations. We performed a retrospective audit on the utilization of neurosurgical operating theatres at Royal Preston Hospital, analysed the times required for various common neurosurgical operations, and broke them down into clinical (operating and anaesthetic) and non-clinical times. We have also looked at the adequacy of available theatre sessions, and the under or over-running of available theatre sessions. A detailed time-based evaluation of 810 procedures over a 16-month period is presented. The mean and 80th centile of the time taken for anaesthesia, surgery and other non-clinical activities are described along with the total time spent in theatre for common neurosurgical procedures. The mean times for transit, preparation for anaesthesia, preparation for surgery, recovery in theatre and time between cases were 16, 13, 14, 15 and 8 minutes, respectively. The mean time duration between the end of one surgical procedure and the beginning of the next was 101 minutes. It was found that actual operating time was surprisingly only 56% of the time available. These data could be used to schedule operating theatre sessions for neurosurgery in the UK, as we believe our practice to be representative of a majority of units in the country.

Audit of the Functioning of the Elective Neurosurgical Operation Theater in India: A Prospective Study and Review of Literature

“…In our study, the actual OT time utilization was 163,442 minutes (2724 hours) as opposed to the scheduled 149,760 minutes (2496 hours) with over-running of OT by 13,682 minutes (228 hours). Similar overutilization of OT was observed in an earlier study (8).…”

“…Anesthesia induction and time for recovery from anesthesia after surgery was 8% and 6%, respectively. In contrast, a higher anesthesia preparation time (5%), induction time (16%), and recovery time (7%) were observed in an earlier study involving neurosurgical patients (8). This shorter anesthesia time in our study could be due to less aggressive invasive monitoring, performance of multiple tasks simultaneously by residents and consultants, and placing additional venous access, arterial line, lumbar drain, or scalp block in parallel with the preoperative surgical preparation (surgical scrubbing and draping of the operative field).…”

“…Only one previous study evaluated the time involved during various neurosurgical procedures (8) and it is compared with our data ( Table 4). Except for the aneurysm surgery, the operative time was longer in our study, whereas the anesthetic time was shorter for all neurosurgical procedures.…”

“…An important aspect of maximizing the utilization of an OT is to know how much time is spent on each activity and there by identify factors resulting in inappropriate utilization of the facility. Very little data are available about the utilization of operating time in a neurosurgical theater (8) despite literature in other operative specialties. (9,18,19) This study therefore aimed at analyzing the utilization pattern of neurosurgery OT time at a tertiary neurosciences center and to identify measurable activities for optimal OT utilization.…”

The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation

“…209 This study provides useful background data on the overall operating theatre time resource demands of intracranial tumour surgery, and also its relative importance within the overall workload of such surgical centres.…”