Patient transportation delays and effects on operation theatres' efficiency: A study for problem analysis and remedial measures

Abstract

Background and Aims:Delay in patients’ transportation to the operating theater (OT) is a globally recognized phenomenon, leading to delay in the subsequent processes (anesthesia induction, surgery, and patient turnover). This observational study was conducted to evaluate the common reasons for delay in transporting patients to the neurosurgery OT complex and its consequent effects and how the elimination of these reasons by application of feasible measures can influence the after effects.Settings and Design:This was an anesthesiologist-based audit of transportation process of patients to the OT complex of a tertiary care teaching hospital to identify the impediments and effects of delay, suggest and implement remedial measures, and assess the outcomes.Materials and Methods:The movement process of successive 551 patients was studied. In the evaluation phase, common reasons for transportation delays were identified. The incidences of consequent effects such as second-case cancellations and overrunning of OTs beyond scheduled hours were noted. In the implementation phase, corrective measures were instituted and the incidences of delays and the consequent effects were again noted.Statistical Analysis:Statistical analysis was performed using SPSS 17.0.Results:In the evaluation phase (303 patients), common reasons for delays included porter-associated delays (15), unavailable lifts (7), and pediatric patients (6). The incidences of case cancellation (20) and overrunning of OTs (9) were high. In the implementation phase, after remedial measures were enforced, the incidences of delays due to porter, lifts, and pediatric patients dropped to 1, 6, and 0, respectively. Simultaneously, a decrease in second-case cancellation (2) and overrunning of OTs (7) also reduced. As an additional finding, a significant reduction in OT turnover times was also observed (16.31 ± 9.29 min vs. 11.70 ± 5.78 min).Conclusions:Analysis of common reasons of patient transportation delays and removal of these impediments can markedly improve the efficiency in OT functioning.

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“…Lack of ease of accessibility of main theatres from the surgical wards and ICU was significantly associated with delays. This is similar to a study by Haldar, et al [23].…”

“…This mirrors a study conducted in Malawi which indicated that there were few staff and too many patients leading to 40% wanting to resign [27]. There were few patient porters causing delays in movement to and from theatre; similarly observed by Haldar, et al [23]. Studies have shown that staff collaboration and teamwork between staff and management were associated with decreased delays in theatres [27,28].…”

“…Infrastructural factors affecting TAT include accessibility of theatres from surgical wards [23], lack of lifts to ferry patients [23], availability of surgical ICU and PACU [24,25], availability of water, electricity and oxygen [26].…”

Why can’t we improve turnover time? A systematic review

“…Studies categorized into this group described interventions that involved redesigning an entire process with multiple individuals and steps. These interventions often employed parallel processing, 9,16,20,21,26–30 redefining/clarifying roles, 12,16,17,22,30–32 reducing nonvalue‐add steps, 16,19–21,30 and standardization of tasks 27,30,33 . This was the most common intervention strategy utilized and was associated with reduced TOT in all but one study 18 .…”

“…Process redesign bundle. WORLD JOURNAL OF SURGERY parallel processing, 9,16,20,21,[26][27][28][29][30] redefining/clarifying roles, 12,16,17,22,[30][31][32] reducing nonvalue-add steps, 16,[19][20][21]30 and standardization of tasks. 27,30,33 This was the most common intervention strategy utilized and was associated with reduced TOT in all but one study.…”