Operation Theatre

Turnaround Time

Presenters:
Aroma Reddy
Pankti Oza
Vrushang Soni
 Objective
• The purpose of our study is to
improve operating room
turnaround time in an for-profit
orthopedic hospital.
 Operation Theatre Turnaround Time

OT turnaround time is
defined as the time Delays in OT lead to fewer
between one patients exit surgical interventions per
and next scheduled day, increases costs and
patients entry to the same decreases efficiency.
OT.
 Background
• The NHS Institute for Innovation and Improvement has determined that a £7
million saving can be achieved per trust by improving theatre efficiency.
• One-third of all operations start 30 mins late or more.
• 38% finish 30 mins early or more.
• More than 111000 finished 60 minutes early than the estimated time.
• The lost theatre time can be used to do 291327 more operations(a 16.8%
increase) per year.
• For orthopedic hospitals 57000 more operations can be done.
 Background continuation……………….

• According to NHS, the appointment of

an orthopedic scheduler, improved
session utilization from 87% to 97%.
• For an average organization a 10%
improvement generates savings of
o£79,200 per week
o£330,000 per month
o£3,960,000 per year.
• 100% utilization was achieved across
the organization it would release
further cost improvements of
£1,188,000 per year.
 Background continuation……………….
• According to JAMA survey, in California,
operating time costs 36 to 37$ per minute.
• But the direct costs were only 20 to 21$
per minute.
• In the inpatient setting, direct costs
accounted for only 54.6% of total
expenses.
• Therefore, in this study we are going to
analyze the cost saving interventions for
the turn around time.
 Hospital name – Care Hospital

Type – For-Profit organization

Number of beds – 800

Type of Entity Number of Staff – 742

Number of OT’s – 5

Surgery Specializations – Foot and Ankle, Hip, Knee,

Upper Limb, Spinal.

Improving OT turnaround means working on

our backlog cases from past 18 months.
PROCESS FLOW DIAGRAM
FISHBONE DIAGRAM
 To reduce mean operation
theatre turnaround time in
AIM Care Orthopaedic Hospital
from 30 minutes to 10
minutes after 6 months.
 Measure the mean
Operation Theatre
MEASURES turnaround time in Care
orthopaedic Hospital
after 6 months.
 •Our data was collected
during the time span of 6
DATA months.
COLLECTION •Data was collected from
operating notes and charts.
PARETO CHART
Sr. Cumulative
No. Loss in Operation Theatre Turnaround Time Frequency Frequency Percentage

1 Delays 387 387 47.48%

2 Inaccurate Length of Surgery 265 652 80.00%

3 Anesthesiologist 75 727 89.20%

4 Staffing 46 773 94.85%

5 Worker's Responsibility 24 797 97.79%

6 Surgical Mishaps 18 815 100.00%

TOTAL FREQUENCY 815

 Pareto Chart
97.79% 100.00%
450 94.85% 100.00%
89.20%
400 387 90.00%
80.00%
350 80.00%
70.00%
300
265
60.00%
250
47.48% 50.00%
200
40.00%
150
30.00%
100 75 20.00%
46
50 24 10.00%
18
0 0.00%
Delays Inaccurate Anesthesiologist Staffing Worker's Surgical
Length of Responsibility Mishaps
Surgery
 POSSIBLE
SOLUTIONS
 (1) Choreograph the process

• Improving theatre efficiency in a cost neutral basis by designing

our interventions accordingly with no extra workforce.
• The list of simple interventions include theatre scrub and
anesthetic clinical staff, theatre managers, surgeons and
anesthetists.
 (2) Create standards of work

• Each task should have not just a standard procedure of what to

do, but also a standard work method that outlines how to do it,
with the right tools and techniques.
• Documentation, training and retraining of staff is needed. In
addition, standards should be specified for outcomes, such as
completion time and quality.
 (3) Create staging

• For any process with a constrained resource such as the OR, staging and kitting can
be very valuable to separate tasks that must happen during the turnover from tasks
that can be done before or after the availability of the resource.
• For example, a dedicated cart with required cleaning equipment and supplies can
be parked outside the OR to be wheeled in as soon as the patient is wheeled out.
Procedure-specific surgical sets can be assembled in advance to be brought in with
the next patient.
• Some teams even leave the instruments in trays rather than lay them out on an
instrument table. The same instruments and materials are verified by count to be
sure nothing has been left in the patient.
 (4) Optimize timing and preparation

• Backward scheduling for the procedure and updated communications

ensure everyone is ready for the process to happen. Consider these
possibilities for timing issues : Finding out the patient had a meal or took
blood thinner meds and can’t undergo anesthesia or surgery, causing a last-
minute change with delays and potential for errors.
• Having cleaning staff on a break at the time of the turnover, also causing big
delays impacting OR utilization.
• Not having a required piece of equipment in the room and learning mid-
procedure that it is in use in another OR and no secondary choice exists.
 DECISION MATRIX

Evaluation Criteria
Proposed Solutions Probability of Ease of Cost Total
Vision
Success Implementation Effectiveness

Choreograph the process 4.6 5 4.6 4.6 18.8

Create standards of work 4.3 2 3.3 4.6 14.2

Create staging 3.6 2.3 4.6 3 13.5

Optimize timing and

3 4.6 3.3 4.3 15.2
preparation
PDSA
 • Ensure strong and visible
leadership
• Create the team
• Communicate, engage
PLAN and raise awareness
• Understand your current
process and gather ideas
• Identify waste
 • The role of clinical leaders may be
important in devising safe, efficient
solutions but also for engaging their
colleagues to improve turnaround
procedures.
Ensure strong • Ensure that your senior theatre
and visible practitioners, coordinators and team
leadership leaders understand the impact of delays
and errors in patient turnaround on the
safety and efficiency of the operating
sessions. Are they driving improvement
and working with their teams to find
‘real time’ solutions?
 • The program team should understand the
importance of involving all groups of staff in
implementing the changes tested in PDSA cycles
as well as evaluating the results.
• Our team includes
Create the § Operating Department Practitioner
§ Theatre manager
team § Anesthetics
§ Recovery and cleaning staff
§ Data analyst
§ Theatre coordinators and team leaders
§ Relevant stakeholders
Communicate, • The teams should communicate regularly
through
engage and • Meetings
• One to one discussion
raise • Posters
awareness • E-mail
• Theatre message book
 • Safe, reliable and efficient patient turnaround relies
upon several important elements coming together.
• They include
• completing the preparation of the next patient
in a timely fashion
Understand • sending for the next patient so they are ready in
the current the anesthetic room (if used)
• transferring the previous patient to recovery
process and handing over their care
• preparing the anesthetic room
• clearing away the instruments from the previous
operation and cleaning the theatre
• setting up the instruments and equipment for
the next procedure.
 1. Defects and rework – due to faulty processes, repeating
things because correct information was not provided in the
first place
2. Motion – unnecessary people movement, travel, walking
and searching. Things not within reach, things that are not
easily accessible
3. Overproduction – producing more than is needed or
earlier than needed by the next process

Identify Waste 4. Transportation – moving materials unnecessarily

5. Waiting – staff unable to do their work because they are
waiting for something such as people, equipment or
information
6. Inventory – too much stock, work in progress or patients
waiting in a queue
7. Over-processing – performing unnecessary steps that do
not add value
 • After reviewing the data we produced
following ideas to implement
• A 15-minute warning to the
preoperative patient area.
• The operating department
DO practitioner (ODP) to check-in next
patient
• Mobilize a dedicated cleaning team
during skin closure.
• Prepare anesthetic room and
instruments for next procedure
• Simultaneous cleaning and sending
 • Test the changes over several PDSA
cycles and monitor progress
• Collect feedback from your teams and
STUDY review it
• Access the impact of key measures on
your aim and communicate progress.
 • When we started implementing our strategy in
the care orthopedic hospital, the mean
operation theatre turn around time was 30
minutes.
WHAT • After continuous improvements made over 6
IMPROVEMENT months, we were able to reduce it to 9.3 mins.
• This exceeds our goal of 10 mins.
OCCURED • This means that our solutions from our decision
matrix had a positive effect on reducing the
operation theatre turn around time.
 10
15
20
25
30
35
40

0
Minutes 5
01-Jul
08-Jul
15-Jul
22-Jul
29-Jul
RUN CHART

05-Aug
12-Aug
19-Aug
26-Aug
02-Sep
09-Sep
16-Sep
23-Sep
30-Sep
07-Oct
14-Oct
21-Oct
Operation Theatre Turnaround time

28-Oct
04-Nov
11-Nov
18-Nov
25-Nov
02-Dec
09-Dec
 • Agree on successful changes for
adaptation
• Agree on changes that should be
removed

ACT • Celebrate and share success

• Continue to monitor and review
• Sustain the changes and plan for scale-
up across all theatres
• Remember to keep on improving
 • Our team worked well together.
Everyone contributed to the discussion
and project. We listened to each others
ideas and did not shut down ideas. We
TEAM provided each other with regular
updates. Everyone did what they said
DYNAMICS they would do and we all helped each
other out. We worked together with
respect and enthusiasm to reach our
goal.
THANK YOU