<p>Looking for ideas and strategies to better utilise your theatres?</p> <p>80% theatre utilisation (time spent on patients) is generally considered an acceptable benchmark, though targets may vary between jurisdictions.&nbsp;</p> <p>But what does that even mean? And how is utilisation being measured?&nbsp;</p> <p>Before we get into some specific strategies that people may want to think about improving their utilisation time, let’s start with the basics.</p> <section class="blogSectionHeading" id="1"> What is Theatre Utilisation? </section> <p>Theatre utilisation is used to measure the amount of time ‘used’ of the total amount of time available within an operating theatre.&nbsp;</p> <section class="blogSectionHeading" id="2"> Why Theatre Utilisation Matters </section> <p>Theatre utilisation is very important (especially to hospital executives and health service funders) because theatres are one of the most expensive assets within a hospital. It’s important to have assurance that these resources are being used well and responsibly.&nbsp;</p> <p>In addition, with demand for hospital services increasing, health departments and hospital executives need to inform their strategies and investments. Looking at utilisation can help them understand if they need to add more theatres to treat patients, or if they can use the theatres they already have more efficiently.</p> <section class="blogSectionHeading" id="3"> Considerations When Measuring Utilisation </section> <p>There are many ways to calculate theatre utilisation. And we’ve found that this leads to some very passionate discussions about the best methods of measurement — especially among surgeons.</p> <p>One of the issues behind this is that a theatre utilisation percentage does not take into account whether patient outcomes were good, or whether procedures were more complex and required more equipment. It also doesn’t consider whether the list had a higher volume of quick, high-turnover cases, leading to more surgeries and more unoccupied time.<br />  </p> <table border="1" cellpadding="1" cellspacing="1" style="width:500px;"> <tbody> <tr> <td><strong>A theatre utilisation percentage does not take into account whether patient outcomes were good.</strong></td> </tr> </tbody> </table> <p> </p> <p>Let's look at a few examples to help illustrate the problem with only looking at utilisation percentages:</p> <ul> <li>A fast surgeon with great outcomes could have a lower theatre utilisation percentage because they operate faster and finish their list in less time.</li> <li>A slower surgeon or trainee might have a very high utilisation but have poorer outcomes because the procedure took longer.&nbsp;</li> <li>An Orthopaedic Surgeon may use a four hour list on two cases, but have high utilisation as there was only one change over.</li> <li>An Ophthalmologist might see seven patients within the same time, but have much lower utilisation as the theatre needed to be cleaned and prepped seven times. &nbsp;</li> </ul> <p>With these examples in mind, it's important that you think about meaningful utilisation and that utilisation is not looked at in isolation when used as a performance metric.</p> <section class="blogSectionHeading" id="4"> How is it Calculated? </section> <p>At its most common form, Theatre Utilisation calculates the percentage of time an operating room is occupied with a patient (used time) in a planned session (total time). It removes any used time prior to the planned start, or after the planned finish. This is also called theatre occupancy.&nbsp;</p> <p>It is also common to look at Elective Utilisation. This is the percentage of time an operating room is occupied with an elective patient only.</p> <p>You may be able to include or exclude certain variables from theatre utilisation calculations, like:</p> <ul> <li><strong>Changeover time </strong>– Since the theatre is being used for necessary tasks</li> <li><strong>Anaesthetic time </strong>– Since this is occurs prior to the surgery</li> </ul> <p>These variables make it slightly more challenging to calculate utilisation. Nevertheless, theatre utilisation can still help teams understand if they are using their theatres well.</p> <section class="blogSectionHeading" id="5"> 6 Theatre Utilisation Strategies </section> <p>If you have worked in theatres for sometime, all of the following strategies will be very familiar to you. They are simple but necessary to ensure you are making the most of your time.</p> <p><br /> Start Each Session On Time<br /> Starting the theatre session on time helps to ensure that the rest of the day can run on schedule. But late starts are common in theatres, with a 2016 audit of QLD public hospitals revealing that 60% of first sessions started late.</p> <p>To tackle this, you could create rosters that enable staff to arrive early enough for the first session so that they have time to scrub and prepare. On days where staff forums or meetings are scheduled, ensure that theatre sessions start later to accommodate these necessary meetings. You may also be able to optimise session start times with better patient or operating room preparation.&nbsp;</p> <p>To improve accountability it is useful (and often mandatory) to &nbsp;record the delay reason for any late starts. This will make it easier to identify whether delays were avoidable and fix any recurrent problems.</p> <p>Reduce Early Finishes<br /> Early finishes are defined as any session where the last case exits the room more than 45 minutes earlier than the scheduled session end time.&nbsp;</p> <p>Finishing earlier than scheduled is good, right? Not necessarily, especially if this is a regular occurrence, because it means you could better utilise your theatre and treat more patients on the waitlist. In some specialties where there are lots of short procedures, like Ophthalmology, General Surgery, and Gynaecology, you may be able to schedule an additional surgery into your day. Of course, for specialties that typically have longer procedures, it’s not always possible to fit another one in.</p> <p>While you’re at it… consider late finishes, too. Late finishes or overruns are defined as any session where the last case exits the operating room more than 30 minutes after the scheduled session end time. Overruns can actually improve theatre utilisation, but they’re a huge problem (and not an ideal solution) because they’re really expensive.&nbsp;</p> <p>Plus, they can cause delays or cancellations to the next scheduled session. If a doctor is experiencing a pattern of late finishes, it’s worth uncovering why and fixing the problem — whether that means allocating additional support or increasing the time allocated for certain procedures.</p> <p>Optimise Changeover Time<br /> Changeover time refers to the amount of time between patients in the operating theatre. A 2016 audit of QLD public hospitals found that patient changeovers took 3.5 minutes or 23% longer than planned, on average. While 3.5 minutes isn’t huge, it can add up by the end of the day.</p> <p>While some changeover time is unavoidable to clean and prepare the space for the next patient, it may be possible to improve times by:</p> <ul> <li>Starting clean up and instrument count prior to finishing surgery</li> <li>Ensuring an orderly and bed is available for the previous patient</li> <li>Ensuring the next patient is ready (and that anaesthetists can get started on time)</li> <li>Scheduling in staff breaks that don’t compromise processes</li> <li>Using anaesthetic bays to begin the next patient while the change over is underway</li> </ul> <p>Reduce Avoidable Day of Surgery Cancellations<br /> Cancellations in theatre can happen for a number of reasons, including:</p> <ul> <li>Delays and emergency operations interfering with the schedule (often the last elective surgery will get cancelled rather than incurring overtime)</li> <li>Inpatient or ICU beds are full</li> <li>Staff absences</li> <li>Patient cancellations or failure to attends</li> <li>Patients not being ready for surgery</li> </ul> <p>Predictive analytics may help to anticipate the volume of emergency surgeries ahead of time so that you can allocate enough resources (including staff and beds) and book elective surgery sessions accordingly.&nbsp;</p> <p>Improved patient communication leading up to the surgery can also help to ensure each booked patient is ready for the day and cancellations can be avoided.</p> <p>Put Patients on Standby<br /> To maximise theatre utilisation, set up a list of patients who are willing to be on standby for surgery cancellations. These patients should be easily contactable, have completed any pre-admission assessments, and be located within a short distance of the hospital.</p> <p>Start with Accurate Data<br /> Ready to get started with improving utilisation? The best place to begin working on theatre utilisation is to look at your data analytics. If you know your numbers, you can quickly find where you’re losing time in theatre and choose targeted strategies that are most likely to lead to improvements.</p> <section class="blogSectionHeading" id="6"> Use SystemView for Theatre Utilisation </section> <p>SystemView can support better theatre utilisation through a number of components and features.</p> <p>Inside the Utilisation component, you can see the number of sessions over time, with a visual graph of how much time patients were in the OR vs how much time they weren't. You can break theatre utilisation trends down by specialty and doctor, with the option to filter by facility, session type (elective vs emergency), timeframe, theatre group, and four calculations:</p> <ul> <li>Operation start time</li> <li>Anaesthetics start time</li> <li>Operation start time (excluding changeover time)</li> <li>Anaesthetic start time (excluding changeover time)</li> </ul> <p>You can also view your theatre utilisation percentage to spot trends over time.</p> <p>Other useful theatre effectiveness components include DOS Cancellations, Knife to Skin, Late Starts, Early Finishes, and Late Finishes.</p> <section class="blogSectionHeading" id="7"> Learn More </section> <p>Want to learn more about hospital improvement or data analytics? Check out these surgical waitlist management strategies and outpatient waitlist strategies! Or subscribe to get updates so you don’t miss our future insights.</p> <style> .blogSectionHeading { font-weight: 600; font-size: 24px; } </style>