- Inefficiencies exist in the operating theatres at the five sample hospitals. We analysed how 37 635 hours of planned elective surgery session time was used in 2014. Just under 25 per cent of this time was not used to treat patients. We estimate that just addressing late starts and early finishes of more than one hour could have feasibly delivered approximately 3 000 hours to treat additional patients. Time was lost because:
- More than a third of sessions did not start on time – when the first case of a session starts more than 10 minutes after the schedule session start time, hospitals consider this to be a late start. In 2014, 37 per cent of elective sessions started more than 10 minutes late, and 11 per cent started more than 30 minutes late. Late starts can cause cancellations of subsequent cases. They can also cause cases to finish after the scheduled end of the session. This results in higher staff costs through the need to pay overtime or provide staff with time off in-lieu.
- Many sessions did not finish on time – 17 per cent of all elective surgery sessions in 2014 finished more than one hour early. This resulted in lost time that hospitals could have feasibly used for more cases, and indicates that theatre booking and scheduling systems do not make the best use of operating theatres.
- Fourteen per cent of elective sessions in 2014 finished more than one hour after the scheduled finish time. Late finishes can result in overtime that may increase staff costs, impact rostering and indicate there are problems such as over booking of sessions.
- Many cases were cancelled on the day of surgery – in 2014, 1 244 elective cases were cancelled on the day of surgery (five per cent of cases). Data indicated that some of these cancellations could have been avoided. Cancellations at short notice can waste costly theatre time, disrupt operating theatre bookings and inconvenience patients.
Read more: Inefficiencies are causing lost operating theatre time
- Poor scheduling is a key cause of inefficiency. Hospitals do not regularly monitor and review schedules to check whether they meet demand, minimise the impact of emergency cases and optimise the use of available theatre time. We found:
- Hospitals did not use all of the planned elective sessions to perform elective surgery. For example, some sessions were reallocated as emergency sessions, while others were not used at all. Issues with the data meant that we could not reliably quantify the hours involved.
- The allocation of elective surgery time to the different specialties did not match need. For example, in the six months of 2014 that we reviewed, the ear, nose and throat specialty at Sir Charles Gairdner Hospital (SCGH) used 20 per cent more sessions than were scheduled, while urology used 10 per cent less.
- Additional operating theatre time could be made available by reviewing session times and adjusting rosters to suit. For instance, up to an additional 1.5 hours per day could be made available through holding all-day sessions instead of two half-day sessions. This would have some rostering implications, but other Australian hospitals use this approach.
Read more: Poor scheduling is a major cause of lost operating theatre time
- Health and the sample hospitals are not making the best use of available data and information to get a clear picture of operating theatre efficiency or the causes of inefficiencies:
- Hospitals did not meet Health’s requirement to report internally on a single indicator of performance, Theatre Activity. Theatre Activity is the proportion of time a theatre is used against the time allocated. It is a different measure to Theatre Utilisation, one of the six established measures we used to assess operating theatre efficiency.
- Theatre Activity is inadequate as a sole measure of performance:
- Theatre Activity alone does not give the full picture of efficiency. We chose six measures used elsewhere in Australia or in Canadian or UK hospitals to assess operating theatre efficiency in the sample hospitals. The way that Health requires Theatre Activity to be measured makes performance look better than it is. For instance, sessions that finish late can achieve results over 100 per cent, boosting the aggregated average.
- Health’s reporting system does not include turnarounds that take more than 45 minutes. This masks real performance by making the average time between cases lower than the real result. For example, our calculation of turnaround time at SCGH, including turnaround times exceeding 45 minutes saw the average in 2014 jump from 11 minutes to 20 minutes.
- Health has recently developed reports for tracking performance by hospital. However these reports are not yet used across all Area Health Services to monitor operating theatre efficiency.
- Hospitals were not making full use of available data to identify efficiency issues. Data analysis is ad hoc, hospitals don’t have suitably skilled data managers and upgrades to improve monitoring and reporting systems have not been made.
- Health provides some opportunities for hospitals to discuss information about improvement strategies. However further work is required to ensure all relevant hospital staff can access information and opportunities:
- Since 2008, Health has provided nearly $2 million to an external provider to develop performance reports at eight hospitals, but implementation of performance monitoring has been limited and there has been no overall improvement to efficiency.
- Hospitals did not routinely use Theatre Management System (TMS) data to identify staff performance issues contributing to inefficiency and address them.
Read more: Health and hospitals can do more to understand and improve operating theatre efficiency