الفهرس 
Operating Room Time UtilizationOnly 14 pages are availabe for public view
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Abstract
Summary
Running an operating room (OR) is a very expensive process. In hospitals of the united states it is estimated that one minute of operating room time costs 62$ (Shippert, 2005). Meanwhile, OR revenue represent the biggest share in hospital revenue, hence come the importance of proper OR management (Marjamaa et al., 2008).
One of the goals of OR management is proper OR utilization which is classically defined as “the ratio of the total OR time used to the total OR time allocated or budgeted” (Strum et al., 1999).. Strum and his colleagues also defined both concepts of “overutilization” and “underutilization” (Strum et al., 1999). Each of under- and overutilization affect the economic efficiency of OR, and thus utilization is targeted to be 85%. However, in complex OR it may be less (Tyler et al., 2003).
Arcidiacono et al. 2015, identified seven important factors that affect OR utilization; (1) Workday of surgery: due to different schedule of each day. (2) Block utilization: it is expected that actual utilization is high if block utilization is found to be high. (3) First-case delay: which is the difference between the scheduled and the actual start time of the first case, it results in underutilization. (4) Cancellation hours; usually this result in underutilization, (5) Total same-day add-on case duration and number of add-ons: opposite to cancellation, this may result in overutilization. (6) Number of turnovers and turnover duration: long turnover increases adjusted utilization. (7) Number of completed cases: The more cases are scheduled; the more OR prime hours are filled.
Services to patients cannot be improved if operating theatres are seen in isolation. The patient’s pathway to his surgery is complex and passes through many stages. Thus, Improving OR performance must consider a wider system, from the decision of surgery to the discharge planning. This requires quality oriented and committed leadership with the authority to make changes based upon high quality data on OR performance, effective communication and co-ordination between managers and front-line healthcare workers in theatres, wards, ICU and preoperative clinics (The Modernisation Agency, 2002).
Cardiothoracic surgeries differ from other surgeries in that they are usually very long and expensive, especially in a hospital that provides tertiary care level. Research regarding time utilization in cardiothoracic services are scarce, hence comes the importance of this research.
The objectives of the study are:
1. To calculate operating room utilization indices in Ain Shams Cardiothoracic hospital.
2. To identify factors affecting operating room utilization in Ain Shams Cardiothoracic hospital.
3. Plan to improve operating room utilization in Ain Shams Cardiothoracic hospital.
This is a cross-sectional study carried out in Cardiothoracic hospital (CTH) of Ain-Shams University. CTH is a tertiary level, highly specialized university hospital that was inaugurated in 2009. It has 5 operating rooms with an average of 1750 surgeries being performed per year. The five operating rooms are assigned as follows: OR1 assigned for pediatric cardio-surgeries, OR2, OR3 and OR5 assigned for adult cardio-surgeries, and OR4 for thoracic surgeries. Working hours of the operation department is from 8 a.m. to 8 p.m. Based on documentations and process review, a high-level flow chart was constructed for the different steps that the patient goes through, also a data collection sheet was designed.
CTH was surveyed for 39 days and data on 286 operation was collected. Data included OR number, day, date, scheduled and actual ranks of the operation regarding rest of operations, first call time, sign in time, operation start time, operation end time and cleaning time.
Main results show that the total mean adjusted utilization for the five ORs was 68.1 ±21.9. no significant statistical difference existed between the ORs. Regarding patterns of utilization at different ORs of CTH, underutilization was the most frequent pattern representing 69% of 142 OR days. Only 15.5% of OR days reached acceptable/optimum utilization levels and 9.9% exceeded to overutilization levels. There was a significant statistical difference between pediatric cardiosurgery (OR1) and adult cardiosurgery (ORs 2,3,5 grouped together) regarding patterns of utilization.
Regarding starting time of operations, 72.9% of surgeries in our sample had a delayed start. Statistically significant difference exists between the ORs as well as between first runs and subsequent runs. Pediatric cardiosurgery OR and subsequent runs show the least percentage of delays. Comparing distribution of scheduled first case delays among working days of the week, Sundays showed the least percent of first case delays (47.8%) while Wednesdays showed the highest (91%) with statistically significant difference between the days. The total median delay interval in CTH was 30 minutes (min). OR1-pediatric cardiosurgery- recorded the highest median delay time (45 min) with statistically significant difference between the five rooms.
A Pareto chart was constructed showing the vital few causes for operation delay. These are “awaiting surgeon” (34.2%), “awaiting anesthetist” (17.7%), which both represent more than 50% of delays and both showed median delay interval of 30 min. Brainstorming session and remedy matrix were used to generate and score remedies to these issues. The top ranked proposed remedy for vital few causes of operation delay is: Improve Communication between Team Members.
Other time intervals measured in this study were “patient first call to Signing-In to the operation department”, “sign-in to operation start interval”, “OR cleaning interval” and turn-over time. These recorded total medians of 15 min.,30 min., 30 min. and 50 min. respectively. Significant statistical difference existed between ORs in all these intervals except “sign-in to operation start interval”.
Studying patterns and causes of elective operation cancellation at CTH, total cancellation rate is 21.3%. pediatric cardiosurgery showed the highest rate of cancellations (29%) with significant statistical difference between the three sub-specialties. The vital few causes of cancellations were “patient prepared as stand by” “previous long operation” “change in Patient’s clinical status”, “equipment failure” and “ICU bed unavailable”. These causes are responsible for 80% of cancellations according to the Pareto Principle. Top ranked proposed remedies for these causes are: “Shifting the patient to another available OR”, “Educating the patient about his role in preparing for surgery”, “Training the staff how to use equipment properly” and “Training the ICU staff”.
It is concluded that all Operating rooms of CTH are underutilized rather than overutilized with an opportunity for improvement especially in thoracic cardiosurgery OR4 and adult cardiosurgery OR5. Pediatric cardiosurgery shows the best time utilization. Operation cancellation frequency as well as sub-specialty are independent factor affecting adjusted time utilization at CTH. CTH has high rates of operation cancellations and start delays. It is recommended to prepare an action plan for remedies proposed to improve both problems. Also, to establish a monitoring and feedback system for time utilization, elective operation cancellation and delay. Establishment of Surgery Booking system based on predicted case duration is also highly recommended.