Tactical Increases in Operating Room Block Time for Capacity Planning Should Not Be Based on Utilization

A two-stage robust optimization approach for the master surgical schedule problem under uncertainty considering downstream resources

This paper addresses a planning decision for operating rooms (ORs) that aim at supporting hospital management. Focusing on elective patients, we determined the master surgical schedule (MSS) on a one-week time horizon. We assigned the specialties to available sessions and allocated surgeries to them while taking into consideration the priorities of the outpatients in the ambulatory surgical discipline. Surgeries were selected from the waiting lists according to their priorities. The proposed approach considered operating theater (OT) restrictions, patients' priorities and accounted for the availability of both intensive care unit (ICU) beds and post-surgery beds. Since the management decisions of hospitals are usually made in an uncertain environment, our approach considered the uncertainty of surgery duration and availability of ICU bed. Two robust optimization approaches that kept the model computationally tractable are described and applied to deal with uncertainty. Computational results based on a medium-sized French hospital archives have been presented to compare the robust models to the deterministic counterpart and to demonstrate the price of robustness.

Most surgeons' daily elective lists in Florida comprise only 1 or 2 elective cases, making percent utilization unreliable for planning individual surgeons' block time

STUDY OBJECTIVE

Operating room (OR) utilization has been shown in multiple studies to be an inappropriate metric for planning OR time for individual surgeons. Among surgeons with low daily caseloads, percentage utilization cannot be measured accurately because confidence limits are extremely wide. In Iowa, a largely rural state, most surgeons performed only 1 or 2 elective cases on their OR days. To assess generalizability, we analyzed Florida, a state with many high-population density areas.

DESIGN

Observational cohort study.

SETTING

The 602 facilities in Florida that performed inpatient or outpatient elective surgery from January 2010 through December 2019.

SUBJECTS

The providers licensed to perform surgery in Florida (physician, oral surgeons, dentists, and podiatrists) were identified by their national provider number. Hospitals were deidentified before analysis.

MEASUREMENTS

The primary endpoint was the mean among facilities in percentages of surgeon-day combinations ("lists") containing 1 or 2 cases. Proportions were calculated using Freeman-Tukey transformation and the harmonic mean of the number of lists at each facility. Comparison to "most" (>50%) used Student's two-sided one-group t-test.

MAIN RESULTS

Averaging among hospitals, most surgeons' lists included 1 or 2 cases (64.4%; 99% confidence interval [CI] 61.3%-67.4%) P < 0.00001). Many lists had 1 case (44.2%, 99% CI 41.2%-47.2%). Nearly all (96.7%) surgeons operated at just one hospital on their OR days.

CONCLUSIONS

Most surgeons' lists of elective surgical cases comprised 1 or 2 cases in the largely urban state of Florida, as previously found in the largely rural state of Iowa. Results were insensitive to organizational size or county population. Thus, our finding is generalizable in the United States. Consequently, neither adjusted nor raw utilization should be used solely when allocating OR time to individual surgeons. Anesthesia and nursing coverage of cases can be based on maximizing the efficiency of use of OR time.

Optimization-driven framework to understand health care network costs and resource allocation

In the last several decades, the U.S. Health care industry has undergone a massive consolidation process that has resulted in the formation of large delivery networks. However, the integration of these networks into a unified operational system faces several challenges. Strategic problems, such as ensuring access, allocating resources and capacity efficiently, and defining case-mix in a multi-site network, require the correct modeling of network costs, network trade-offs, and operational constraints. Unfortunately, traditional practices related to cost accounting, specifically the allocation of overhead and labor cost to activities as a way to account for the consumption of resources, are not suitable for addressing these challenges; they confound resource allocation and network building capacity decisions. We develop a general methodological optimization-driven framework based on linear programming that allows us to better understand network costs and provide strategic solutions to the aforementioned problems. We work in collaboration with a network of hospitals to demonstrate our framework applicability and important insights derived from it.

Monitoring Perioperative Services Using 3D Multi-Objective Performance Frontiers

The Acute Care Surgery model has been widely adopted by hospitals across the United States, with Acute Care Surgery services managing Emergency General Surgery patients that were previously being treated by General Surgery. In this analysis, we evaluate the impact of an Acute Care Surgery service model on General Surgery at the University of Vermont Medical Center using three metrics: under-utilized time, spillover time, and a financial ratio of work Relative Value Units over clinical Full Time Equivalents. These metrics are evaluated and used to identify three-dimensional Pareto optimality of General Surgery prior to and after the October 2015 tactical allocation to the Acute Care Surgery model. Our analysis was further substantiated using a Markov Chain Monte Carlo model for Bayesian Inference. We applied multi-objective Pareto and Bayesian breakpoint analysis to three operating room metrics to assess the impact of new operating room management decisions. In the two-dimensional space of Fig. 2, panel a), the post-tactical allocation front lies closer to the origin representing more optimal solutions for productivity and under-utilized time. The post-tactical allocation front is also closer to the origin for productivity and spillover time as shown in the two-dimensional space of Fig. 2, panel b). The results of the three-dimensional multi-objective analysis of Fig. 3 illustrate that the GS post-tactical allocation Pareto-surface is contained within a much smaller volume of space than the GS pre-tactical allocation Pareto-surface. The post-tactical allocation Pareto-surface is slightly lower along the z-axis, representing lower productivity than the pre-tactical allocation surface. This methodology might contribute to the external benchmarking and monitoring of perioperative services by visualizing the operational implications following tactical decisions in operating room management.

Ethics in contemporary health care management and medical education

RATIONALE

The health care landscape is changing: it has become the largest part of the economy and changes in public management systems will greatly affect how we practice medicine in the future. Medical education will be more important than ever to ensure patients get the best care with empathy. However, new public management systems implemented without thorough analysis might challenge medical education. An increasing number of public health care institutions provide services based on competitive market rules and express their goals in financial terms and have set financial gains as their main goal, which contradicts the fundamental nature of medical ethics and practice.

AIMS AND OBJECTIVES

To explore new public management to identify potential problems and offer possible solutions for medical education and health care institutions.

METHODS

A scoping review of the literature on public administration, hospital management, professionalism, ethics, and medical education was undertaken to map evidence on the topic and identify main concepts and knowledge gaps in the influence of management systems on the quality of medical educational practices.

RESULTS

If the accelerating changes in public management are cursorily analysed, medical education may lose the esteem in which it has long been held globally. Without precautions, the so-called new public management medical faculties will-at best-generate economic benefit, following a business model with strict quality rules, regulations, standardized products, and complex analysis and measurement systems. However, these faculties will function at a level far below the ideal of teaching institutions distinguished for their outstanding components, creativity, and ambience.

CONCLUSIONS

Patients and teaching values are not reducible to financial terms only and the acknowledgement of non-financial values is fundamental to achieve quality in health care and education. The most essential step could be selecting managers who will implement public management principles while taking into account both business requirements and medical ethics.

A Statistical Model-driven Surgical Case Scheduling System Improves Multiple Measures of Operative Suite Efficiency: Findings From a Single-center, Randomized Controlled Trial

OBJECTIVE

We sought to determine whether a data-driven scheduling approach improves Operative Suite (OS) efficiency.

BACKGROUND

Although efficient use of the OS is a critical determinant of access to health care services, OS scheduling methodologies are simplistic and do not account for all the available characteristics of individual surgical cases.

METHODS

We randomly scheduled cases in a single OS by predicting their length using either the historical mean (HM) duration of the most recent 4 years; or a regression modeling (RM) system that accounted for operative and patient characteristics. The primary endpoint was the imprecision in prediction of the end of the operative day. Secondary endpoints included measures of OS efficiency; personnel burnout captured by the Maslach Burnout Inventory; and a composite endpoint of 30-day mortality, myocardial infarction, wound infection, bleeding, amputation, or reoperation.

RESULTS

Two hundred and seven operative days were allocated to scheduling with either the RM or the HM methodology. Mean imprecision in predicting the end of the operative day was higher with the HM approach (30.8 vs 7.2 minutes, P = 0.024). RM was associated with higher throughput (379 vs 356 cases scheduled over the course of the study, P = 0.04). The composite rate of adverse 30-day events was similar (2.2% vs 3.2%, P = 0.44). The mean depersonalization score was higher (3.2 vs 2.0, P = 0.044), and mean personal accomplishment score was lower during HM weeks (37.5 vs 40.5, P = 0.028).

CONCLUSIONS

Compared to the HM scheduling approach, the proposed data-driven RM scheduling methodology improves multiple measures of OS efficiency and OS personnel satisfaction without adversely affecting clinical outcomes.

The financial value of vascular surgeons as operative consultants to other surgical specialties

OBJECTIVE

Vascular surgeons provide assistance to other surgical specialties through planned and unplanned joint operative cases. The financial impact to the hospital of vascular surgeons as consultants in this context has yet to be quantified. We sought to quantify the financial value of services provided by consulting vascular surgeons in the performance of joint operative procedures, both planned and unplanned.

METHODS

Hospital financial data were reviewed for all inpatient operative cases during a 3-year period (2013-2015). Cases in which a vascular surgeon provided operative assistance as a consultant to a nonvascular surgeon were identified and designated planned or unplanned. Contribution margin, defined as hospital revenue minus variable cost, was determined for each case. In addition, the contribution margin ratio (contribution margin divided by revenue) was determined for each cohort. Financial data for consulting cases was compared with all nonconsult cases. Data analysis was performed with nonparametric statistics.

RESULTS

There were 208 cases with a primary nonvascular surgeon that required a vascular co-surgeon during the study period, 169 planned and 39 unplanned. For comparison, 19,594 nonconsult cases of other surgical specialties were identified. The median contribution margin was higher for vascular surgery consult cases compared with nonconsult cases ($14,406 [interquartile range, $63,192] vs $5491 [interquartile range $28,590]; P = .002). The overall contribution margin ratio was higher for vascular surgery consult cases (0.41) compared with control nonconsult cases (0.35). There was no difference in contribution margin and contribution margin ratio between planned and unplanned vascular surgery consult cases.

CONCLUSIONS

Vascular surgeons provide essential operative assistance to other surgical specialties. This operative assistance is frequent and provides significant financial value, with high contribution margin and contribution margin ratio. Vascular surgeons, as consulting surgeons, enable the completion of highly complex cases and in this capacity provide significant financial value to the hospital.

Keys to optimizing operating room efficiency

Healthcare is in constant transformation. Health systems should focus on improving efficiency to meet a growing demand for high-quality, low-cost health care. The operating room is one of the biggest sources of revenue and one of the largest areas of expense. Therefore, operating room management is a critical key to success. The aim of this article is to analyze the current principles of organization, optimization and clinical management of the operating room and its impact on the quality and safety of care.

Role of Surgical Services in Profitability of Hospitals in California: An Analysis of office of Statewide Health Planning and Development Annual Financial Data

With constant changes in health-care laws and payment methods, profitability, and financial sustainability of hospitals are of utmost importance. The purpose of this study is to determine the relationship between surgical services and hospital profitability. The Office of Statewide Health Planning and Development annual financial databases for the years 2009 to 2011 were used for this study. The hospitals’ characteristics and income statement elements were extracted for statistical analysis using bivariate and multivariate linear regression. A total of 989 financial records of 339 hospitals were included. On bivariate analysis, the number of inpatient and ambulatory operating rooms (ORs), the number of cases done both as inpatient and outpatient in each OR, and the average minutes used in inpatient ORs were significantly related with the net income of the hospital. On multivariate regression analysis, when controlling for hospitals’ payer mix and the study year, only the number of inpatient cases done in the inpatient ORs (β = 832, P = 0.037), and the number of ambulatory ORs (β = 1,485, 466, P = 0.001) were significantly related with the net income of the hospital. These findings suggest that hospitals can maximize their profitability by diverting and allocating outpatient surgeries to ambulatory ORs, to allow for more inpatient surgeries.

A new decision support model for preanesthetic evaluation

BACKGROUND AND OBJECTIVE

The principal challenges in the field of anesthesia and intensive care consist of reducing both anesthetic risks and mortality rate. The ASA score plays an important role in patients' preanesthetic evaluation. In this paper, we propose a methodology to derive simple rules which classify patients in a category of the ASA scale on the basis of their medical characteristics.

METHODS

This diagnosis system is based on MR-Sort, a multiple criteria decision analysis model. The proposed method intends to support two steps in this process. The first is the assignment of an ASA score to the patient; the second concerns the decision to accept-or not-the patient for surgery.

RESULTS

In order to learn the model parameters and assess its effectiveness, we use a database containing the parameters of 898 patients who underwent preanesthesia evaluation. The accuracy of the learned models for predicting the ASA score and the decision of accepting the patient for surgery is assessed and proves to be better than that of other machine learning methods. Furthermore, simple decision rules can be explicitly derived from the learned model. These are easily interpretable by doctors, and their consistency with medical knowledge can be checked.

CONCLUSIONS

The proposed model for assessing the ASA score produces accurate predictions on the basis of the (limited) set of patient attributes in the database available for the tests. Moreover, the learned MR-Sort model allows for easy interpretation by providing human-readable classification rules.

Productivity benchmarks for operative service units

BACKGROUND

Easily accessible reliable information is crucial for strategic and tactical decision-making on operative processes. We report development of an analysis tool and resulting metrics for benchmarking purposes at a Finnish university hospital.

METHODS

The analysis tool is based on data collected in a resource management system and an in-house cost-reporting database.

RESULTS

The exercise reports key metrics for four operative service units and six surgical units from 2014 and the change from year 2013. Productivity, measured as total costs per total hours, ranged from 658 to 957 €/h and utilization of the total available resource hours at the service unit level ranged from 66% to 74%. The lowest costs were in a unit running only regular working hour shifts, whereas the highest costs were in a unit operating on 24/7 basis. The tool includes additional metrics on operating room (OR) scheduling and monthly data to support more detailed analysis.

CONCLUSION

This report provides the hospital management with an improved and detailed overview of its operative service units and the surgical process and related costs. The operating costs are associated with on call duties, size of operative service units, and the requirements of the surgeries. This information aids in making mid- to long range decisions on managing OR capacity.

Simulation-Based Optimization for Surgery Scheduling in Operation Theatre Management Using Response Surface Method

Operation theatre is one of the most significant assets in a hospital as the greatest source of revenue as well as the largest cost unit. This paper focuses on surgery scheduling optimization, which is one of the most crucial tasks in operation theatre management. A combined scheduling policy composed of three simple scheduling rules is proposed to optimize the performance of scheduling operation theatre. Based on the real-life scenarios, a simulation-based model about surgery scheduling system is built. With two optimization objectives, the response surface method is adopted to search for the optimal weight of simple rules in a combined scheduling policy in the model. Moreover, the weights configuration can be revised to cope with dispatching dynamics according to real-time change at the operation theatre. Finally, performance comparison between the proposed combined scheduling policy and tabu search algorithm indicates that the combined scheduling policy is capable of sequencing surgery appointments more efficiently.

"Knife to skin" time is a poor marker of operating room utilization and efficiency in cardiac surgery

BACKGROUND

Markers of operation room (OR) efficiency in cardiac surgery are focused on "knife to skin" and "start time tardiness." These do not evaluate the middle and later parts of the cardiac surgical pathway. The purpose of this analysis was to evaluate knife to skin time as an efficiency marker in cardiac surgery.

METHODS

We looked at knife to skin time, procedure time, and transfer times in the cardiac operational pathway for their correlation with predefined indices of operational efficiency (Index of Operation Efficiency - InOE, Surgical Index of Operational Efficiency - sInOE). A regression analysis was performed to test the goodness of fit of the regression curves estimated for InOE relative to the times on the operational pathway.

RESULTS

The mean knife to skin time was 90.6 ± 13 minutes (23% of total OR time). The mean procedure time was 282 ± 123 minutes (71% of total OR time). Utilization efficiencies were highest for aortic valve replacement and coronary artery bypass grafting and least for complex aortic procedures. There were no significant procedure-specific or team-specific differences for standard procedures. Procedure times correlated the strongest with InOE (r = -0.98, p < 0.01). Compared to procedure times, knife to skin is not as strong an indicator of efficiency. A statistically significant linear dependence on InOE was observed with "procedure times" only.

CONCLUSIONS

Procedure times are a better marker of OR efficiency than knife to skin in cardiac cases. Strategies to increase OR utilization and efficiency should address procedure times in addition to knife to skin times.

Using a best-practice perioperative governance structure to implement better block scheduling

Achieving, developing, and maintaining a well-functioning OR scheduling system requires a well-designed perioperative governance structure. Traditional OR/surgery committees, consisting mainly of surgeons, have tried to provide this function but often have not succeeded. An OR governance model should be led by an OR executive committee that functions as a board of directors for the surgery program and works closely with the surgery department medical director and an OR advisory committee. Ideally, the OR executive committee should develop a block schedule that includes a mix of block, open, and urgent or emergent OR access, because this combination is most effective for improving OR use and adapting to changes in surgical procedure volume.

Criteria for assessing operating room utilization in a free-standing children's hospital

BACKGROUND

  The staffed hours of operation in any surgical facility are a valuable institutional resource. The realistic target for the utilization of this resource is dependent on many factors including scheduling, efficiency, and culture of the facility. There is no previously reported measure for the actual utilization of staffed regular operating room (OR) hours in an academic pediatric institution. The leadership of the perioperative services at Children's Hospital Boston (CHB) sought to define the utilization of surgical suite staffed block time hours at that institution and in addition determine whether changes in workflow could increase the measured utilization.

METHODS

  Operating room efficiency in fiscal year 2009 was measured using two variables: utilization and turnover measured in hours for each month in fiscal year 2009, recorded in hours expressed as ratios (observed/expected) and as differences (observed - expected). A total of 27,851 cases from October 1, 2008, through September 30, 2009, were analyzed. All elective cases were scheduled electronically following institutional guidelines; urgent or emergent procedures were scheduled into vacant time slots on the day of the procedure. Time series analysis based on a generalized autoregressive moving average process was used to compare expected with observed utilization and to evaluate changes in utilization and turnover ratios.

RESULTS

  Efficiency as measured by capped utilization divided by total available time in the OR averaged 79%. Utilization ratios ranged from a low of 73% in February 2009 to a high of 87% in July 2009. An improvement in on-time first-case starts may have contributed to the increase in the utilization of staffed block time. Turnover time as defined by turnover ratio decreased significantly over time, indicating an improved efficiency in the OR starting in April 2009.

CONCLUSIONS

  Adhering to the specific guidelines that are followed at CHB, the mean utilization of scheduled block time was 79%. This was achieved by maximizing workflow in the surgical, anesthesia, and nursing disciplines to shorten turnover time, fill gaps in the elective schedule with emergency procedures, and provide staffing to accommodate cases that extend beyond the scheduled staffed time prior to the reporting period. Simulated models from other pediatric institutions suggest that the optimal utilization of designated time periods in a surgical facility may range from 85% to 90%.

Perspective: Hospital support for anesthesiology departments: aligning incentives and improving productivity

Anesthesiology groups, particularly academic departments, are increasingly dependent on hospital support for financial viability. Economic stresses are driven by higher patient acuity, by multiple subspecialty service and call demands, by high-risk obstetric services, and by long case durations attributable to both case complexity and time for teaching. An unfavorable payer mix, university taxation, and other costs associated with academic education and research missions further compound these stresses. In addition, the current economic climate and the uncertainty surrounding health care reform measures will continue to increase performance pressures on hospitals and anesthesiology departments.Although many researchers have published on the mechanics of operating room (OR) productivity, their investigations do not usually address the motivational forces that drive individual and group behaviors. Institutional tradition, surgical convenience, and parochial interests continue to play predominant roles in OR governance and scheduling practices. Efforts to redefine traditional relationships, to coordinate operational decision-making processes, and to craft incentives that align individual performance goals with those of the institution are all essential for creating greater economic stability. Using the principles of shared costs, department autonomy, hospital flexibility and control over institutional issues, and alignment between individual and institutional goals, the authors developed a template to redefine the hospital-anesthesiology department relationship. Here, they describe both this contractual template and the results that followed implementation (2007-2009) at one institution.

Curriculum providing cognitive knowledge and problem-solving skills for anesthesia systems-based practice

BACKGROUND

Residency programs accredited by the ACGME are required to teach core competencies, including systems-based practice (SBP). Projects are important for satisfying this competency, but the level of knowledge and problem-solving skills required presupposes a basic understanding of the field. The responsibilities of anesthesiologists include the coordination of patient flow in the surgical suite. Familiarity with this topic is crucial for many improvement projects.

INTERVENTION

A course in operations research for surgical services was originally developed for hospital administration students. It satisfies 2 of the Institute of Medicine's core competencies for health professionals: evidence-based practice and work in interdisciplinary teams. The course lasts 3.5 days (eg, 2 weekends) and consists of 45 cognitive objectives taught using 7 published articles, 10 lectures, and 156 computer-assisted problem-solving exercises based on 17 case studies. We tested the hypothesis that the cognitive objectives of the curriculum provide the knowledge and problem-solving skills necessary to perform projects that satisfy the SBP competency. Standardized terminology was used to define each component of the SBP competency for the minimum level of knowledge needed. The 8 components of the competency were examined independently.

FINDINGS

Most cognitive objectives contributed to at least 4 of the 8 core components of the SBP competency. Each component of SBP is addressed at the minimum requirement level of exemplify by at least 6 objectives. There is at least 1 cognitive objective at the level of summarize for each SBP component.

CONCLUSIONS

A curriculum in operating room management can provide the knowledge and problem-solving skills anesthesiologists need for participation in projects that satisfy the SBP competency.

How work context affects operating room processes: using data mining and computer simulation to analyze facility and process design

The complexity of the operating room (OR) requires that both structural (eg, department layout) and behavioral (eg, staff interactions) patterns of work be considered when developing quality improvement strategies. In our study, we investigated how these contextual factors influence outpatient OR processes and the quality of care delivered. The study setting was a German university-affiliated hospital performing approximately 6000 outpatient surgeries annually. During the 3-year-study period, the hospital significantly changed its outpatient OR facility layout from a decentralized (ie, ORs in adjacent areas of the building) to a centralized (ie, ORs in immediate vicinity of each other) design. To study the impact of the facility change on OR processes, we used a mixed methods approach, including process analysis, process modeling, and social network analysis of staff interactions. The change in facility layout was seen to influence OR processes in ways that could substantially affect patient outcomes. For example, we found a potential for more errors during handovers in the new centralized design due to greater interdependency between tasks and staff. Utilization of the mixed methods approach in our analysis, as compared with that of a single assessment method, enabled a deeper understanding of the OR work context and its influence on outpatient OR processes.

Measuring the Effects of Information Systems on the Performance of Operating Rooms (OR)

The paper applies various qualitative and quantitative methods to measure the influence of information technology on the performance of operating rooms (ORs). It provides a comprehensive set of indicators to evaluate the impact of IT on the quality, efficiency and performance of ORs. This set of indicators was further enriched by conducting interviews with hospital professionals. The result is a new set of performance indicators, divided into five major categories: productivity, efficiency, quality, cost savings and employee satisfaction. This set of indicators serves as a basis for a weighed performance model that can be applied as a useful tool for selecting new OR information systems. Additionally, the model can be used for improving existing applications. The research identifies time registration, integration with the medical and financial systems of the hospital and production of activity queries and reports as the most common functions of ORs systems. However, despite their potential to contribute to productivity, efficiency and quality of ORs, automatic conflict recognition, material and personnel planning are less frequently applied by hospitals. Finally, the paper highlights the links between efficient use of OR systems, larger volumes of operations and higher occupation rates, and assists in identifying positive effects of systems used in ORs on their performance.

Patient mix optimisation and stochastic resource requirements: a case study in cardiothoracic surgery planning

Cardiothoracic surgery planning involves different resources such as operating theatre time, beds, IC beds and nursing staff. In the daily practice of the Thorax Centre case study setting, the planning focuses on optimal use of operating theatre time, though the performance of the Thorax Centre as a whole is often more limited by other resources. For operating theatres a master surgical schedule is used to allocate operating theatre resources at tactical level for a longer period. Operational schedules at weekly level are derived from this master schedule. Within cardiothoracic surgery different categories of patients can be distinguished based on their requirement of resources. The mix of patients operated is, therefore, an important decision variable for the Thorax Centre to manage the use of these resources. In this paper we will consider the planning problem at the tactical level to generate a master surgical schedule that realises a given target of patient throughput and optimises an objective function for the utilisation of resources. The problem can be mathematically approached by mixed integer linear programming, which we already demonstrated in a previous paper. The specific topic of the current paper is to investigate the influence of using a stochastic instead of a deterministic length of stay. We will discuss the new mathematical model developed for this planning problem. The results obtained by the model indicate that we can generate master surgical schedules with a better performance on target utilization levels of resources by considering the stochastic length of stay.

Alteration in emergency theatre prioritisation does not alter outcome for acute appendicitis: comparative cohort study

BACKGROUND

Despite dedicated emergency theatre, emergency surgery can be often delayed due to competing urgencies, suggesting a need for innovative theatre time management.

AIM

To investigate if a change in the emergency theatre prioritisation affects outcomes for a common urgent operation such as appendicectomy.

METHODS

We prospectively recorded data from 67 patients undergoing appendicectomy, for two cohorts of patients: before and after change in theatre prioritisation: Group 1 (Jan-Mar) and 2 (Aug-Oct) respectively. Demographic and peri-operative data, time from admission to surgery, postoperative length of stay and total length of stay and complications were compared.

RESULTS

The two groups were comparable with regards to gender, age, time of admission and histological confirmation of appendicitis. No differences between the two groups were found regarding time from admission to surgery (24.4 (95% CI 11.2;27.6) hours versus 16.1 (95% CI 10.4;21.7) hours, Mann-Whitney U test, p = 0.35), postoperative length of stay (90.8 (95% CI 61.4;120.1) hours versus 70 (95% CI 48.3;91.6) hours, Mann-Whitney U test, p = 0.25) and total length of stay (115.2 (95% CI 84.6;145.7) hours versus 86 (95% CI 61.6;110.4) hours, Mann-Whitney U test, p = 0.07) as well as complication or re-admission rates.

CONCLUSION

A change in the emergency theatre prioritisation does not affect outcome for appendicectomy. Provision of a second emergency theatre could be a solution to reduce the delays in acute surgical operations.