title: The cost of trauma operating theatre inefficiency.
abstract: The National Health Service (NHS) is currently facing a financial crisis with a projected deficit of £2billion by the end of financial year 2015/16. As operating rooms (OR) are one of the costliest components in secondary care, improving theatre efficiency should be at the forefront of efforts to improve health service efficiency. The objectives of this study were to characterize the causes of trauma OR delays and to estimate the cost of this inefficiency. A 1-month prospective single-centre study in St. Mary's Hospital. Turnaround time (TT) was used as the surrogate parameter to measure theatre efficiency. Factors including patient age, ASA score and presence of surgical and anaesthetic consultant were evaluated to identify positive or negative associations with theatre delays. Inefficiency cost was calculated by multiplying the time wasted with staff capacity costs and opportunity costs, found to be £24.77/minute. The commonest causes for increased TT were delays in sending for patients (50%) and problems with patient transport to the OR (31%). 461 min of delay was observed in 12 days, equivalent to loss of £951.58/theatre/day. Non-statistically significant trends were seen between length of delays and advancing patient age, ASA score and absence of either a senior clinician or an anaesthetic consultant. Interestingly, the trend was not as strong for absence of an anaesthetic consultant. This study found delays in operating TT to represent a sizable cost, with potential efficiency savings based on TT of £347,327/theatre/year. Further study of a larger sample is warranted to better evaluate the identified trends.
authors.affiliation: Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
authors.forename: W W
authors.initials: WW
authors.lastname: Ang
authors.affiliation: Imperial College Healthcare NHS Trust, Department of Orthopaedics, The Bays, South Wharf Road, St Mary's Hospital, London, W2 1NY, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sabharwal
authors.affiliation: Imperial College Healthcare NHS Trust, St. Mary's Hospital, Praed Street, London, Greater London, W2 1NY, UK.
authors.forename: H
authors.initials: H
authors.lastname: Johannsson
authors.affiliation: Imperial College Healthcare NHS Trust, Department of Orthopaedics, The Bays, South Wharf Road, St Mary's Hospital, London, W2 1NY, UK.
authors.forename: R
authors.initials: R
authors.lastname: Bhattacharya
authors.affiliation: Imperial College Healthcare NHS Trust, Department of Orthopaedics, The Bays, South Wharf Road, St Mary's Hospital, London, W2 1NY, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Gupte
keywords: Cost-analysis; Efficiency savings; Orthopaedics; Theatre delays; Theatre efficiency