An evaluation of operating room throughput in a stand-alone soft-tissue trauma operating theatre

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DOI: http://dx.doi.org/10.21454/rjaic.7518.241.wal

Brian D O’Donnell1, Ken Walsh1, Aileen Murphy2, Brendan McElroy2, Gabriella Iohom1, George D Shorten1
1 Department of Anaesthesia, Cork University Hospital, and University College Cork, Ireland
2 Department of Economics, University College Cork, Cork, Ireland


Background. Operating room time is a limited, expensive commodity in acute hospitals. Strategies aimed at reduction of non-operative time improve operating room throughput and capacity. We conducted a prospective study to evaluate and augment operating room throughput and capacity using context-specific work practice changes.

Methods. Following institutional and ethical approval, an interdisciplinary group designed and introduced a series of work practice changes specific to a stand-alone soft tissue trauma theatre, comprising modifications to patient processing, staff behaviours and additional anaesthesiologist hours. Time intervals relating to each patient were measured during a 16 week period before and after implementing work practice changes.
The primary outcome measure was non-operative time, with daily caseload and cancellations amongst secondary outcome measures.

Results. 251 procedures were included over 58 working days (8 to 17 Monday to Friday). Nonoperative time [55.6 (31.1) vs 52.3 (9.8) minutes, p = 0.48], daily caseload [4 [1-9] vs 4 [2-7], p = 0.56], and the number of daily cancellations [3 [0-11] vs 5 [0-8], p = 0.38], did not differ between baseline and study phases. Regional anaesthesia for upper limb surgery increased during the study phase [26/59 (44.0%) vs 10/63 (15.9%), p = 0.014] with resultant decrease in mean duration of recovery room stay [20.7 (17.7) vs 30 (20.5) minutes, p = 0.0001] and increased recovery room bypass [26/116 (22.4%) vs 6/135 (4.4%), p = 0.0002]. Avoidable delays accounted for 124.8 (72.2) minutes of theatre time lost each day.

Conclusion. In conclusion, additional attending anaesthesiologist hours combined with work practice changes did not impact on measures of theatre throughput and capacity. The study identified important variables that contribute to avoidable delays, and points the way for future research.

Keywords: operating theatre, soft-tissue trauma, parallel processing, anaesthesia, case duration