Delays to Operating Theatre Lists: Observations from a UK Centre

摘要

The aim was to measure the incidence of delays to operating theatre lists and the reasons behind them. A cost implications analysis was also performed to discover the potential savings to be made from improvement in this aspect of theatre efficiency. Prospective surveys recording start-time delays and total daily delay during 227 multiple-specialty cases were completed over five days in March 2010 in a UK District General Hospital, split over two sites. Information was collected onto a proforma for each case about specialty, procedure, start-time and end-time of the case, with request for an explanation for duration and reason for any delays incurred. An analysis of costs to the Trust was performed using estimated theatre hours lost with average cost of theatre use per hour.Overall 78% of cases started on time, i.e. within 15 minutes of the scheduled time, but orthopaedics and plastics achieved only 69% and 66% respectively. Orthopaedics and plastics also exceed the acceptable total daily delay time of 45 minutes (70 and 66 minutes respectively). Hospital-wide factors were the most common reason for the delays (72%). 48% were due to ward bed issues, 15% due to doctor factors and 13% inadequate pre-operative assessment. Estimated projected cost to the Trust over one year is significant at over ￡1 million ($1.5 million).During the study period, theatre time was lost for usually multi-factorial reasons, with hospital organisational factors being predominant. Opportunities to improve theater efficiency were identified. Introduction The UK District Audit Commission has described a number of key theatre performance indicators, which include theatre time utilisation and patient flow1. Operating theatre efficiency is important to reduce costs to the NHS and to keep patient waiting lists minimised. The key elements in the efficient use of operating theatres are effective management and good communication, trained staff, appropriate facilities, equipment and operational layout. A widerange of surrounding resources such as pre-operative planning and assessment, bed availability, theatre supplies and staffing levels also influence efficiency. Theatre efficiency is economically important, as demonstrated in the UK by The Productive Operating Theatre (TPOT), a modular improvement programme created by the NHS Institute with aims to improve theatre safety, efficiency and patient care in the UK, saving ￡7 million ($10.5 million) for an average UK Trust2. Cost of consumables increases with the number of operations performed, however, operational cost remains fixed whether one procedure or more are performed, so improving turnover will result in a reduction in the unit cost of surgery. Aims The purpose of this survey is to gain insight into the theatre efficiency and hence cost-effectiveness by the measure of incidence and reason for delays to operating theatre lists.Audit StandardsA number of methods have been used to assess and quantify theatre efficiency, including proportion of available theatre time used for anesthesia and surgery, list cancellation, late running lists and start-time delays. As there is no specific UK NICE guidance on theater delays our standards were derived from the Association of Anaesthetists of Great Britain and Ireland (AAGBI) theater efficiency guide3 along with US comparative studies4-6. Start-Time delaysStart-time delay is a useful indicator of operating theater efficiency. The start time of cases is defined as ‘when the anesthetist takes charge of the patient in preparation for anesthesia’. Minimal start-time delays reduce the time patients have to wait, maximises the number of cases achieved per session and reduces further cancellations and so waiting lists for the hospital. From comparative studies at least 75% of patient’s procedures should start within 15 minutes of the time scheduled. Therefore 15 minutes late is classified as a ‘delay’ to the list progression. If a case is supposed to start at 9am but the ca