9. Effective Utilisation of Theatre Time for Elective Surgery

• It is important that all lists begin and end at times agreed and adhered to by all theatre users. The advantages of this include:-


• Anaesthetists will have time to visit patients pre-operatively before the agreed start of the operating list.


• Timely preparation of patients for theatre.


• Increased ability to match staff to workload in theatres and recovery units.


• Staff can take meal breaks, reducing fatigue


• A reduction in the need for overtime


• A prompt start in the afternoon with less chance of overrun into the evening.


• Realistic scheduling of meetings, professional and other commitments [9].


• The start of a theatre session is defined as, ‘when the anaesthetist takes charge of the (first) patient in preparation for anaesthesia’ and the end as, ‘when the anaesthetist has finished handing the (last) patient over to recovery staff and is free to start another task’.


• It is important that lists are scheduled in such a way that surgical and anaesthetic time is synchronised. For example, infectious patients should be put on the end of the list to avoid delays caused by contamination of the theatre; patients requiring only local anaesthesia administered by the surgeon and no monitoring by an anaesthetist, at the beginning or the end of the list. Pooling of such patients onto one list may enable the anaesthetist to be reallocated.


• Realistic scheduling of procedures will avoid cancellation of operations. Potentially long operations should be identified and planned in such a way that it is possible to complete them within the time available.


• Computerised collection of data on operating times of individual surgeons and anaesthetists for different procedures makes it relatively easy to predict probable overruns and automatically flag this up to the medical secretary or scheduling clerk who can alert the surgeon to rearrange the list.


• Operating lists may over-run due to unforeseen circumstances; dealing with this should not involve the use of the emergency team.


• All-day lists using the same theatre team, including surgeon and anaesthetist can be particularly efficient and should be encouraged. There should be provision for meal and comfort breaks, however, and overall operating time should not be in excess of the number of planned sessions.


• Scheduled evening lists have been implemented in some trusts with mixed success.


• Day surgery lists increase overall efficiency and usually have a high utilisation time. Effective utilisation is increased by the provision of purpose-built selfcontained and autonomous premises.


• It is both unreasonable and unfair to rely on the anaesthetist to instigate curtailment of overrunning lists by cancellation of scheduled cases. A culture of good time keeping within the operating theatre, encouraged and enforced by the theatre manager, will facilitate such decisions.