Improving operating theatre efficiency: an intervention to significantly reduce changeover time

Abstract

Background: Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays. Methods: A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken. Results: There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13). Conclusion:The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times.

Clinical management issues vary by specialty in the Victorian Audit of Surgical Mortality: a retrospective observational study

“…‘Delay in definitive treatment’ was identified as the most severe clinical management issue from this study and from the national report data 13. In orthopaedic clinical studies on hip fracture patients, delay in definitive treatment was shown to be attributable to patient factors such as age and comorbidities, as well as waiting times to theatre 14 15. In the aggregate results, ‘communication issues or poor documentation’ was in the top seven clinical management issues.…”

An audit of operating theatre utilisation and day-of-surgery cancellations at a regional hospital in the Durban metropole

“…[1] Escalating healthcare costs and limited state health budgets necessitate an efficient theatre service to maximise service delivery and reduce costs. [2] The Lancet Commission has highlighted the need for scaling up surgical services in low-and middle-income countries to increase access to essential surgery. [3] Scale-up will place an increased burden on existing resources, further emphasising the importance of optimising use of available theatre time.…”

A systematic review of intraoperative process mapping in surgery

“…Surgical care is encompassed in the perioperative period which includes three phases: preoperative, intraoperative, and postoperative. The intraoperative period contains the execution of the surgery; it is of interest as it utilises the operating theatres (OT), and a large proportion of a hospital's total expenses come from here (6).…”

“…The OT is a complex environment to optimise, with efficiency influenced by factors such as: case scheduling, cancelled cases, on-time starts, procedure time variation (which is influenced by equipment, patient factors, individual surgeon skill, and case complexity), turnover time, administrative factors (i.e., bed management), and the surgical team (i.e., junior staff who are still training) (6,8,9). Understanding what factors contribute to efficiency in the intraoperative period can allow for improvements to be formulated and implemented; process mapping could help to achieve this.…”