Theater Sending: How Long Does It Take and What Is the Cost of Late Starts?

Abstract

Last minute cancellations of scheduled surgery are a waste of health care resources and an emotional burden on patients. A common reason for cancellation is poor theater time utilization. Several studies have demonstrated that in some cases 50% of lists overran their scheduled time and more than 40% started late. In a recent prospective study of 55 elective gynecological operations, 25% of the theater session was wasted by delays related to transfer of patients to and from the operating theater; the median waiting time between cases was 22.5 minutes for surgeons and 7 minutes for anesthetists. The aim of this retrospective study was to examine the theater transit of patients through theaters and estimate the cost of delays, especially the cost of late starts. The study subjects were 238 patients undergoing elective gynecological operations during a 3-month period in 2008 at a single hospital. After exclusions, 164 patients were included in the final analysis. Primary study outcome measures included time to send, time for anesthesia, and procedure time. Secondary outcome measures included time to send for the first patient (calculated as waiting time resulting from late starts) and the estimated cost of late starts. The mean time to send (time between sending and arrival in anesthetic room) was 19 ± 8.1 minutes; the 95% confidence interval [CI] was 18 to 20. The mean time for anesthesia (time between arrival in anesthesia room and arrival in theater) was 9 ± 6.4 minutes (95% CI: 8–10). The mean procedure time (time between arrival in theater and end of procedure) was 60 ± 35 minutes (95% CI: 55–65). The mean time to send for the first patient on the morning list (representing the mean wait time of the surgical team for the first patient) was 20 ± 9.83 minutes (95% CI: 17–23). The delayed arrival of the first patient resulted in a late start in 93% of morning lists. The mean wait time of the surgical team after the first patient on the morning list was due to start was 22 ± 19 minutes (95% CI: 17–27). During the 3-month study period, the total time wasted as a result of late starts was 910 minutes (15 h) at an estimated cost of £3640. The investigators conclude from these findings that sending patients 30 minutes before the list is due to start could increase theater efficiency and save 15 hours of currently wasted time.