Improving quality and efficiency in operating theatres brings a range of benefits in both the short-term and the long-term:
- Reduced turnaround time between procedures.
- Improved patient care and infection control.
- Happier and more motivated staff.
- Huge financial savings – The NHS Institute for Innovation and Improvement estimates that a more productive operating theatre can help the average trust save more than £7 million.
How Much Do Operating Theatres Cost to Run?
Various sources suggest that operating theatres cost between £560 and £1,200 an hour to run. However, there is no recent data available and most sources date back to around 2015. Costs are likely to have risen significantly since then, especially when you take increases in energy costs into account. Improving quality and efficiency in operating theatres comes down to making the absolute most out of all available time and resources. It’s also about understanding the costs associated with downtime.
How to Create a More Productive Operating Theatre
A productive operating theatre is optimised to improve a patient’s experience and outcomes. There are three key areas to focus on to achieve this:
- Team performance and staff wellbeing
- Safety and reliability of care
- Value and efficiency
First, you need to assess how your operating theatre is managing right now.
How to Audit your Current Operating Theatre Practices
Start with a comprehensive audit of your operating theatre practices. The NHS Productive Operating Theatre strategy recommends that financial leaders should commit to a walk-around of their operating theatres to better understand the issues that frontline staff face every day.
The aim is to assess the operational status of each theatre in your trust. Here are some areas to focus on:
- Is all the necessary equipment available and working?
- Are the right staff in the right place at the right time?
- Do operating lists start on time? If not, how often are they delayed, and by how much time are they delayed on average?
- How often does the theatre face cancellations and delays?
- Do operating lists finish on time?
Obviously, all theatres will encounter unexpected issues from time to time. But when they do, the operating team should be equipped to identify and escalate issues in a timeless and efficient manner. And when faced with a problem, all plans should be flexible enough that you can make small adjustments to get the day back on schedule.
What Does a Well-Organised Theatre Look Like?
In a well-organised operating theatre, everything and everyone is in the right place at the right time, and ready to go whenever needed.
To work towards a well-organised theatre, the NHS Institute for Innovation and Improvement recommends a system called 5S: Sort, set, shine, standardise, sustain.
- Sort – Remove any non-essential items from the area.
- Set – Assign each object an ideal area in the room and organise all the necessary materials and equipment so that it’s easy to access.
- Shine – Regularly clean and maintain the operating theatre environment.
- Standardise – Once you establish procedures for maintaining orderly, clean and functional work areas, decide how similar areas can be arranged in the same way.
- Sustain – Commit to regular audits to ensure that everyone maintains the high standards you set.
How to Reduce Waste in Operating Theatres
The NHS Institute for Innovation and Improvement identifies seven key sources of waste in operating theatres:
- Defects and rework. If you don’t provide the correct information in the first place, or if your processes are faulty, the operating team will have to repeat certain procedures to ensure they’re done right.
- If things are not within easy reach, or if they’re not easily accessible, operating teams will have to spend more time than necessary searching for what they need. Also, if the operating theatre isn’t properly organised, people will have to move, walk, and travel much more than necessary.
- Either people produce more than what is needed, or they produce things earlier than necessary for the next process.
- Are you moving any materials that really don’t require moving?
- If staff don’t get the equipment, information, or support they need when they need it, they’ll have no choice but to wait. And when they’re waiting, they’re not working.
- In an inefficient operating theatre, there’ll be more stock than necessary, too many processes taking place at once, and too many patients waiting in a queue.
- Over-processing. Everything every member of the team does in an operating theatre should add value. In an inefficient operating theatre, there’ll be an excess of unnecessary steps that don’t add value, they only serve to waste time, motion, and resources.
Improving Patient Preparation and Turnaround
Poor patient preparation can cause a lot of stress, anxiety and uncertainty for both the patient and their relatives. But on an operational level, poor patient preparation can also result in late starts, costly changes to the list order, multiple delays, and even potentially harmful errors and mistakes.
In a well-organised operating theatre, every patient will arrive in the theatre prepared for surgery:
- At exactly the right time.
- With an identity band in place, and with all their notes complete and accessible.
- Fully-informed and consented.
- With their operation site marked.
Efficient patient turnaround means that not a single second is wasted between the end of one surgical procedure and the start of the next. This can involve several processes occurring at the same time, including:
- Handing over the patient to recovery staff.
- Clearing away instruments and cleaning the operating theatre environment.
- Setting up all instruments and equipment for the next procedure, including the anaesthetic equipment.
- Performing the check-in and sign-in procedures for the next patient.
Operating Theatre Consumables and Equipment
As we’ve seen, a crucial aspect of a productive operating theatre is that everyone needs to be able to access the equipment they need, when they need it. Nobody should ever have to stop a process to search for the necessary equipment, and nobody should ever find that their equipment is broken, faulty, or out of date just when they’re about to use it.
Also, the theatre team should always have all the equipment they need to cover the number of scheduled procedures. And there should never be any issues concerning skills and competency when using new equipment.
The choice of equipment in an operating theatre can also make a huge difference to efficiency. For example, the right sort of absorbent operating theatre floor mats can help manage health and safety risks while simultaneously improving operational efficiency. As non-drip mats can be picked up and discarded, doing away with the need to mop floors, operating teams can significantly reduce the turnaround times between procedures without compromising on hygiene standards.
Improving Quality and Efficiency in Operating Theatres – Full Guidance
The Productive Operating Theatre is a series of modules designed to help theatre teams work together to improve the quality of the patient experience and the safety of surgical services. The resource outlines ways in which theatres can make best use of available time and expertise.
You can download a suite of modules covering every aspect of a productive operating theatre, including equipment and consumables, patient preparation and turnaround, the handover procedure, and effective teamwork and procedure scheduling.
Head here to access the full suite of Productive Operating Theatre resources.
Whether you want a consultation on effective infection control, or some advice on improving operational effectiveness in the theatre, our experts are here to help.