Student Dissertation

Agency : Operation Theatre; Utilization; Delays; First Case Delays

Objective : To compare the Operation Theatre Utilization of January 2018- March 2018 with January 2017 – March 2017. • To determine the capacity utilization and the actual utilization time of Operation Theatres of the study hospital during the study period. • To find out the reasons for the gap in available working time and utilization time of the OT • To suggest measures to improve the utilization of the OT.

Background : OR utilization is defined by Donham and colleagues as “the quotient of hours of OR time actually used during elective resource hours and the total number of elective resource hours available for use”. Improving the performance of operating theatres is key to achieving shorter waiting times for treatment, implementing the booking of elective operations and reducing canceled operations. As the growth of the hospital is also determined by the performance of its Operation Theatre, the use of the Utilization study could be underscored for this purpose. Utilization studies have traditionally proven to guide the managers as it reports the results of the routine practices of the Operation Theatre and helps them in decision making and planning interventions to improve the processes. This study is undertaken to assess the functioning of Operation Theatre with respect to utilized hours as compared to available hours.

Methodology : • Study design This was a cross-sectional study based on a retrospective record review and prospective observations of the daily activities of the Operation Theatres of Thumbay Hospital, Dubai. • Study setting The study setting was the operating theatres of Thumbay Hospital, Dubai • Duration of study The study period was three months, 10th February 2018 to 19th April 2018. Comparisons were done between the two years (1 January 2017 to 1 March 2017and 1 January 2018 to 31 March 2018), for different variables used in this study. Utilization of the Operation Theatres is calculated on data collected from 19 February 2018 to 19 April 2018. • Data Management Quantitative data was collected using a data collection tool. Data variables collected for the study: • Comparison study: Variables are studied for the first quarter of 2017 and 2018: Total no. of surgeries, Department wise no. of surgeries, Department wise major and minor surgeries, No. of surgeries per surgeon, Overall utilization percentage per month • Utilization study: Scheduled Time, Patient in Time, Patient On table Time, Patient Shift out Time, utilized hours, Delay

Findings : utilization of the Operation Theatre has improved over the years, and the average utilization of the Operation Theatre during the study period was 45%. This study highlights the major observations that influenced the utilization of the OTs, and observations related to first case delays and delays in Operation theatre. First case delays were observed on 17 out of 51 working days of February- March 2018. General surgery contributed to 35% of incidents of first case delay, with maximum first case delay caused due to delay in admission. Other reasons for first case delays were, Delay from the ward, delay from the surgeon’s side and delay due to interruption because of emergency surgery. Overall average delay during the study period was 47 minutes and it was observed in 19% of the total 382 observed cases. Major reasons for the overall delay was due to delay in patient arrival (31%) and incomplete consent (29%).

Recommendations : Determining the major causes and bottlenecks creating hurdles in the smooth functioning of Operation Theatres and correcting them without any lag is imperative to increase the utilization of Operation Theatres. Observations related to improper management of the OT list and lack of adequate resources were seen. Development of Operation Theatre Information Management System and ensuring sufficient resources in terms of manpower and instruments/ equipment’s can considerably improve the utilization of Operation Theatres.