Factors influencing peri-operative delays in neurosurgery operating theatres: a prospective study

Abstract

BackgroundReduction of perioperative delays optimises theatre efficiency, and may provide an opportunity to improve the quality of healthcare delivered. The aim of this quality improvement project was to elucidate the prevalence, causes and impact of perioperative delays in Neurosurgery theatres at our local institution. MethodsA prospective audit analysing elective Neurosurgery cases was conducted from 1st Sept ‘18 to 28th Feb ’19 (6 months).Quantitative and qualitative analysis was performed on data from the Operating Room Scheduling Office System (ORSOS) real-time data capture forms and a custom-made survey filled out by theatre staff. NHS Benchmarking Network national neurosurgery theatre data were utilised as a control group. ResultsA total of 461 (90%) cases started late (average delay of 49 minutes and 21 seconds), 32% (n=164) cases finished early and 31 minutes was the average turnaround time. There was 16.8%(n=124) cancellation rate and 76% theatre utilisation. The most commonly cited causes for late start were lack of patient readiness (62.1%), change in list order (5.3%), anaesthetic delay (5.3%), surgeon delay (4.5%), turnaround delay (2.3%), bed issues (2.3%), emergency (1.5%), fire alarm (0.8%), kit delay (0.8%) and multi-factorial (15.2%). The total cost of late start delays over the study period was £304,266.18. ConclusionsThis study showed late-starts and early-finishes as part of sub-optimal theatre utilisation. Cost-saving could be immense if corporate factors improve such as availability of appropriate beds along with clinical ‘human’ factors. To ameliorate these delays, we are currently implementing strategies to improve compliance of lumbar spinal surgery as day-case guideline. In order to ensure long-term sustainability, this implementation will be re-audited using a Plan-Do-Study-Act cycle in 6 months’ time.