Abstract of Dissertation

Keyword : Operation Theatre; NABH Guideline; Utilization of OT

Objective : This study has been conducted with the objective of reducing avoidable cancellations and delay of scheduled surgical cases, increase utilization of OT, ensuring compliance of in-patient files, proper maintenance of records and registers.

Background : Operation theatre complex is a revenue-generating department as well as costly to operate. It is a necessity to ensure that it is utilized efficiently which requires efforts and proper coordination amongst doctors, paramedical and non-paramedical staff along with the department of billing, sterile equipment supply. There are various standards as per NABH to operationalize OT to provide excellence of services and ensure patient safety

Methodology : A prospective analytical study, conducted over a period of three months duration from February to April 2018. In this study, instruments used are CPRS audit checklist, Surgical Safety Audit Checklist, Staff Awareness Audit Checklist, Daily data on status and delay of OT. Primary and secondary data were collected from CPRS, hospital records. The sample size included all the scheduled cases of OT in the above-mentioned period. Quantitative analysis of collected data on a number of cases within time, delayed, add ons, canceled and of CPRS audit checklist, surgical safety audit checklist using Microsoft excel was done. Qualitative analysis of staff awareness audit.

Findings : The data analysis showed a major cause of cancellation to be patient did not turn up with prior OT booking in March 45% which declined to 33% in April with following up canceled cases, 25% cases got canceled due to a fitness issue. Enhanced utilization of OT -1, 4, 5, 6 and CS OT, Daycare OT in April than March observed along with an increase in the number of cases in all except OT 3. On comparing with March, in April average TAT decreased in OT3, OT 5, OT 7, CS OT. Remained unchanged in Daycare OT. A slight increase in OT 1 and OT 2 observed. TAT compliance improved in all except OT-1 and OT-3. Compliance of initial assessment improved to 89% in April, VTE prophylaxis documentation to 93.93%, OT notes by performing team to 100%, transfer notes compliance significantly improved from 22.72% to 69%, allergy assessment from 70% in February to 81% in April. Compliance of pain assessment and estimated blood loss by surgeons was found to be 0%. Surgical safety audit analysis revealed compliance of site marked on patient 58.3%, side marked on patient 100%, Site marking documented 85.1%, Antibiotic prophylaxis documentation: 80%, WHO surgical safety checklist compliance of sign In 92%, time out 88%, sign out 98%. Compliance of date 88% and time 60% in the consent form. Blood loss documentation in anesthesia record 30.61%, in surgical safety checklist 98%. In anesthesia record documentation of induction time 100%, incision time 97.9%, shifting time 84% and pre-op checklist completion seen in 84 % files.

Recommendations : Continuous efforts of reinforcement on adherence to standard protocols. Behavior change communication to ensure the implementation of standard practices. Training of staff on awareness and importance of documentation, quality indicators of OT. Proper coordination and communication between various surgeons, anesthetists, departmental coordinators, billing desk, front office, nursing staff, and technicians. Frequent audits and timely meetings to monitor and review utilization and compliance of OT.