Table 3. Potential areas of improvement identified in studies. Themes for potential improvement areas are listed under “Major areas”. Elaboration on how each theme was represented in each study is listed under “Specific areas of improvement”.

Major areas	Specific areas of improvement
Preoperative planning	Inadequate laboratory tests and imaging prior to surgery (7,24,25,27)
Anaesthetic period	Inconsistent anaesthetic/sedation protocol, medication and equipment used (7,13,20-23,26), delayed anaesthetic pre-evaluation and preparation (19,20)
Paperwork	Incomplete (i.e., delay in obtaining patient consent) (13,20,23), excess paperwork (24), redundant paperwork (21,22,28)
Instrument trays	Delay in preparation of instrument trays (13,19,20,27), inadequate availability of instruments (13,20,27), delay in instrument processing (20,27)
Surgeons	Late arrival to OT (20,28), delayed pre-evaluation (21), supervision of trainees (15,16)
Steps in process	Re-performing steps (15), step(s) with highest time variance (7,14,16-18,24,25), longest operation step (14,17,18), variable number/type/sequence of steps to complete a task (14,16,26), unnecessary steps (25)
Patient transport	Delay in transfer of patient to OT (13,19,20), delay in transfer of patient out of theatre into post-operative ward (20,22)
OT scheduling	Surgical case volume variation (21)
Staff	Inconsistent intraoperative team members (e.g., surgeons, anaesthetists, nurses, and OT technicians) (7,20,25), insufficient staff (24), lack of pre-defined roles and responsibilities (25,26)
Training	Inadequate understanding of surgical process, related to surgical preparation of instruments, trainee inexperience, and rotation of trainees (19,20,23,24)
Communications	Inadequate communication between team members (15,20,21)
Patient factors	Late arrival to preoperative holding area and check-in (20,21), health status/anatomical differences (17,18)

OT, operating theatres.