Since the March issue of the Annals, the following letters have been published on our website <http://www.rcseng.ac.uk/publications/eletters/>:
letter . 2006 May;88(3):269. doi: 10.1308/003588406X106478
letter Ann R Coll Surg Engl. 2006 May;88(3):269. doi: 10.1308/003588406X106478
Ann R Coll Surg Engl. 2006 May;88(3):269. doi: 10.1308/003588406X106478
In our opinion, the 75% theatre utilisation rate reported in this study is reasonable. We would further argue that a utilisation rate of 75–85% is optimal as attempts to maximise it beyond this level predisposes to other inefficiencies, such as patient cancellations at the end of the list or session overruns.
Adequate bed capacity is required for elective inpatient operations to take place. Therefore, amelioration of poor main theatre usage probably requires consideration of bed expansion or ‘ring-fencing’ in many hospitals rather than a theatre remedy per se.
Comparison of utilisation rates between theatre units is hazardous. In this study, the authors adjusted utilisation calculations in overrunning lists to include overtime as an addition to the allocated session duration. In the 2003 Audit Commission report, however, some hospitals quoted utilisation rates in excess of 100%.1 The latter almost certainly arose from a failure to adjust session duration to include overtime. Hence, it might be that in some centres high utilisation rates actually reflect poorly managed theatres where overruns occur commonly. Specific advice on the definition and measurement of theatre utilisation has been offered by the Modernisation Agency's Theatre Programme.2 As such, until uniformity of calculation has been adopted, theatre utilisation rates should best be regarded with some caution.
References
- 1.Audit Commission. Operating theatres: Review of national findings. London: Audit Commission; June 2003. [Google Scholar]
- 2.NHS Modernisation Agency. Step Guide to Improving Operating Theatre Performance. London: NHS Modernisation Agency; 2002. [Google Scholar]
Ann R Coll Surg Engl. 2006 May;88(3):269. doi: 10.1308/003588406X106478
We thank Mr Faiz and Mr Leather for highlighting the fact that improving theatre efficiency requires consideration of multiple factors, including the bed capacity, and not simply the running of theatres per se. Bed shortages for elective surgery, particularly in winter months when demand for acute medical beds is at a peak, often lead to last-minute patient cancellations that disrupt planned lists. This may significantly negate any advantages produced from improving the efficiency of the operating theatre itself and, therefore, careful planning and ‘ring-fencing’ of beds for surgery are very important considerations.
We also agree that comparison of utilisation rates between units is neither valid nor useful until a standardised method of calculating operating efficiency is agreed upon. Utilisation rates in excess of 100% are clearly due to lists over-running and it is for this reason that our study clearly separated the analysis of lists that finished early and lists that over-ran. The intention of the study was to provide a snapshot of possible inefficiencies in the system that could be targeted and, hopefully, this has generated a healthy debate.
letter Ann R Coll Surg Engl. 2006 May;88(3):269. doi: 10.1308/003588406X106478
Ann R Coll Surg Engl. 2006 May;88(3):269. doi: 10.1308/003588406X106478
This article makes alarming reading. Whatever is going on? If the NHS cannot provide a proper trauma service, why is anyone concerned about ‘targets’ for in-growing toenail surgery? Any surgical service must make the proper provision of care for emergencies its first priority - and all surgical training must ensure that all surgeons can deal with life-threatening conditions.