A surgeon-led model to improve operating theatre change-over time and overall efficiency: A randomised controlled trial.
BACKGROUND
The non-operative time during the process of patient change-over between operating theatre cases is a significant source of delay and overall theatre inefficiency. The aim of this study was to integrate and trial a working strategy to improve this change-over time.


METHODS
This was a single-blinded, randomised controlled intervention study comparing a surgeon-led, team-based model of strategies versus routine patient change-over. This model was trialled by a single surgeon, and the primary outcome was the difference in change-over times compared with 4 other surgeons who were blinded and served as controls. Secondary outcome measures included overall differences in complications between the groups, and the number and differences in operative case cancellations due to inadequate theatre time.


RESULTS
1265 patients were randomised into 5 general surgical lists, and included all major and minor cases. Median number of operative cases were 214 per surgeon, with an overall median change over time of 17.9 ± 3.7 min. Surgeon A in the intervention group had a median change-over time of 12.1 ± 5.4 min (p < 0.001), with a median difference of 8.5 min ± 21.4 min (p < 0.0001), translating to a 58% reduction in median change-over time between the intervention and control groups. There were no differences in complication rates amongst the groups. The intervention group had no cancellations due to lack of time, compared with 37 cancellations in the control group.


CONCLUSIONS
This study demonstrates a statistically significant improvement in median change-over times using this model. This re-design can be implemented without incurring extra costs, staff, or operating theatres.
Department of General Surgery, Caboolture Hospital, McKean Street, Caboolture, QLD 4510, Australia; University of Queensland, UQ Medical School, Brisbane, QLD 4067, Australia. Electronic address: ryo.mizumoto@uqconnect.com.au.
Ryo
R
Mizumoto
Department of General Surgery, Caboolture Hospital, McKean Street, Caboolture, QLD 4510, Australia; University of Queensland, UQ Medical School, Brisbane, QLD 4067, Australia. Electronic address: adamcristaudo@bigpond.com.
Adam Thomas
AT
Cristaudo
Department of General Surgery, Caboolture Hospital, McKean Street, Caboolture, QLD 4510, Australia; University of Queensland, UQ Medical School, Brisbane, QLD 4067, Australia. Electronic address: rasika.hendahewa@health.qld.gov.au.
Rasika
R
Hendahewa
D017598:Efficiency, Organizational; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration* / Q000592:standards; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors; D017748:Time Management / Q000379:methods* / Q000458:organization & administration
Non-operative time; Operating theatre/room efficiency; Operating theatre/room patient changeover/turnover; Parallel processing; Resource utilisation