Surgical time and motion: the intermediate equivalent revisited

Abstract

S urgeons' operative work-load has by tradition been assessed by weighting individual operations for complexity on the basis of the BUPA schedule of procedures.1 Each operation can be given an intermediate equivalent value (IEV), or hernia equivalent, in order to convert the case-load to a work-load.It has been suggested that a consultant surgeon in a district general hospital might perform 3-4 intermediate equivalents per operating list, which would amount to a total operative work-load of 900 intermediate equivalents per year.2 However, our own prospective audit over a period of 3 years has raised questions regarding the accuracy and correlation between the weighting given and certain common complex major operations by the BUPA schedule, 3 and the actual time taken to perform the surgery. The aim of this study, therefore, was to determine whether a relationship exists between the intermediate equivalent weighting of a surgical operation, anaesthetic preparation time, operative time, and the complexity of commonly performed general surgical operations. A clear and consistent relationship between the intermediate equivalent rating of an operation, and the actual theatre time required to complete the procedure, would allow transparent planning of operating lists with regard to available operating theatre time, and facilitate accurate audits of a work-load. MethodsThe operative work-load of 9 consultant surgeons working in a district general hospital serving a population of 480,000 was studied retrospectively. General surgical services are provided by 8 general surgeons, two vascular,

Workload and Resource Implications of Upper Gastrointestinal Cancer Surgical Centralisation in South East Wales

“…Sixty-eight new oesophagogastric cancers were detected during the study period of which 24 underwent potentially curative surgery (35%) compared to 14 of 33 (42%) in the first 6 months of the study (P = 0.488) and 298 (33%) in the all-Wales audit reported by Pye et al 7 Concerns have been published regarding the applicability of intermediate equivalents when applied to major oesophagogastric cancer surgery. 22 Recalculating the IE values in this study with regard to the above, based on 6 IEs per D2 gastrectomy, and 8 per oesophagectomy, produces an oesophagogastric cancer operative workload of 188 IEs following centralisation equating to 116 IEs per SEV per year. This equates to 21% of the total operative workload advised in College guidelines, compared with 17% previously reported from a district general hospital with one specialist upper gastrointestinal surgeon.…”

A Randomized Prospective Time and Motion Comparison of Techniques to Process Autologous Fat Grafts

“…Time and motion studies allow observers to continuously monitor workflow and record time spent or time allocated to each step. 15,[17][18][19][20][21] In particular, surgical procedures can be objectively assessed in an effort to streamline the procedure, define roles and expectations of team members, improve resource utilization, and identify areas of improvement. 16,22,23 This is the first prospective, randomized clinical study in autologous fat grafting using time and motion methodology to compare the rate of tissue processing of three commonly used systems in autologous fat grafting.…”