Operating Theatre Management Toolkit

Toolkit
Operating Theatres
A toolkit of the Patient Flow Collaborative

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Department of Human Services
Toolkit
Introduction Goals of the toolkit Overview and strategy Health service team
Operating theatres
Introduction
What is the operating theatre toolkit for? The operating theatre toolkit has been designed to develop organisation wide strategic management of current operating theatre services and promote best practice. What are the aims of the toolkit? The patient flow collaborative aims to remove unnecessary constraints or delays in the patient process. It is recognised that operating theatre utilisation will deliver effective and efficient service to aid patient flow.
Who should use the toolkit? The toolkit will promote discussion and innovate solutions around possible present constraints. Anyone with responsibility for effective theatre utilisation will benefit from this tool. How should the concepts be implemented from this toolkit? Local theatre innovation teams should discuss tools and concepts adapting these to their local context.
Processes
Data
Resources
Diagnostics and tools

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Toolkit
Operating theatres
Goals of the toolkit

Introduction The operating theatre toolkit is based on whole system thinking and includes a whole of hospital perspective on effective and efficient theatre utilisation. Support services play a large part in maximising efficiency by providing: Pre-operative preparation and assessment Available beds Sterile theatre equipment Goals Key elements to efficient use of operating theatres are: Effective management Portering, cleaning and maintenance staff. Effective planning and scheduling systems will enable smooth patient flow thus increasing capacity, improving patient and carer experience, improved employee satisfaction and morale.
Processes
Good communication
Data
Well trained staff Appropriate facilities and equipment Operational layout that allows flow of patients.
Your feedback Feedback on this first version of the operating theatre toolkit is welcome and will be used to update subsequent versions.
Resources

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Toolkit
Introduction Goals of the toolkit Overview and strategy
Operating theatres
Overview and strategy

Key elements
Theatre Management structure Staffing
Health service team
Planning patient pathways
Postponements
Processes
Data
Operating list management Trauma and emergencies
Resources
Effective use of theatre time
Theatre design
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Toolkit
Postponements
Operating theatres

Theatre Management structure
Theatre management structure

Theatre Management structure Staffing
Theatre management structure should be clearly defined with accountability for: Full budgetary authority Adequate sessional allowance Information systems Utilisation Administrative, medical and nursing staff.
Theatre design
Processes
Day to day management should be provided by an experienced trained and skilled theatre manager, who is responsible for clear communication, ensuring competent staffing and suitable equipping of all theatres. Suitable systems for planning activity should be available to allow allocation of staff, and to respond safely and flexibly when changes take place to routines. Policies should be developed to deal effectively with changes to operating lists. Operating lists should be clearly posted well in advance and in suitable locations. Theatre management team should regularly review utilisation, cancellations, list overruns, late starts and waiting lists.
Data
Resources

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Toolkit
Trauma and emergencies Postponements
Operating theatres

Planning patient pathways Theatre Management structure Staffing
Operating list management
Theatre design
Planning patients pathways Patients pathways should take into account ways to maximise use of theatres and bed availability. Patients admitted to pre-operative units can be transferred to wards following surgery allowing time for discharge of previous patients. Integration of pre-operative assessment and day case recovery area located adjacent to theatres provides an efficient use of space, skilled staff and may aid patient transport to and from theatres. This scheme also reduces time on ward rounds for surgeons and anaesthetist as patients are in one place.
Processes
Data
Resources

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Toolkit
Operating theatres

Staffing
Theatre design
Staffing Anaesthetic departments should provide a system of staffing that works locally and is acceptable to staff Department staffing should match clinical activity, with sufficient cover for elective and emergencies Robust systems for booking leave must be in place and owned by all, with an advertised leave policy A lead anaesthetic consultant should be identified to support the theatre management team and trainees Adequate orientation of new or locum staff should be made a priority Adequate staffing should be available to cover governance tasks of note recording and data entry.
Processes
Data
Resources

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Operating theatres

Theatre design
Operating list management Close communication and coordination between pre-op area and theatre using agreed procedures is essential A nominated person should liaise with wards and transport staff from theatres A suitable holding area staffed and equipped will assist with smooth flow Agreement should be made for preparation and transport of patients to and from theatres Policies on fasting, anticoagulation, shaving, dentures, jewellery, appropriate underwear and removal of make-up should be developed Units should agree the level of training needed to escort patients to and from theatres A documented system of handover and identification of patient should be in place A system to book critical care beds for elective admissions should be in place and booking confirmed before anaesthesia for surgery.
Processes
Data
Resources

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Toolkit
Operating theatres

Theatre design

Processes
It is important that all theatre lists start and finish at the agreed time. Agreement should be made to make this possible. Realistic scheduling of theatres will prevent cancellations All day theatre lists have proven efficient, within the synchronising of surgical and anaesthetic time and staffing Good time keeping principles should be adopted and monitored by the theatre management team Pro-active re-allocation of cancelled theatre lists.
Data
Resources

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Toolkit
Operating theatres

Theatre design
Theatre design
Theatre design and operational layout

Processes
Design of operating theatres is essential for maximising patient flow, consideration needs to be made for: Large multi-purpose accommodation to enable increase in complexity and equipment Transport routes that flow through stages of theatre care Internal communication IT systems that facilitate appropriate communication and supervision.
Data
Resources

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Toolkit
Operating theatres

Trauma and emergencies

Theatre design
Trauma and emergency surgery Effective planning for emergency and trauma surgery is needed to prevent cancellation of elective surgery. Provision of exclusive emergency list will assist in preventing cancelled elective surgery.
Processes
Data
Good communication enables clinical decisions to be made rapidly, increasing the number of surgical procedures carried out in a safe time and environment. Time should be allowed for the Anaesthetist to assess emergency patients to their satisfaction. Experienced surgical staff should prepare patients who have multiple and complex medical problems, this can prevent cancellation at anaesthetic assessment. Pre-operative assessment for patients who are elderly, have multiple and complex medical problems can benefit from a team approach between anaesthetist, surgeon and physician.
Resources

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Toolkit
Postponements
Postponements
Operating theatres

Theatre design
Cancellations of surgery It is extremely distressing and stressful to patients who are postponed surgery, many cancellations can be prevented by assisting patient flow with good planning in: Bed management Pre-operative assessment Increased communication
Processes
Data
Resources
Regular review of cancellation can assist with target areas for redesign and innovation. Cancellation data should be collected and reviewed weekly with agreed action plans. End of section

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Toolkit
Operating theatres
Health service team

Theatre design
Processes
It is essential for operating theatre innovation to have a skilled, trained and committed innovation team. The team should consist of representatives of all theatre staff groups. Management clinical/non clinical Nursing Pre op and theatres, including operating department practitioners Clinical Anaesthetist/Surgeons Administration Admin and Portering
Data
Resources

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Toolkit
Operating theatres
Processes
Initial recording of overall patient processes should be made covering:
Admission
Receive patient to ward following operation
Processes
Data
Administration Processes will also need to map demonstrating process from:
Resources
Allocation to theatre list
Theatre reception on day of operation

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Toolkit
Operating theatres
Processes
Process map groups
Theatre
Theatre
Bed
ICU
Theatre
Recovery
Recovery
Theatre
Theatre
ICU
Processes
Home
Bed
HDU/ITU
ICU
Bed
Data
Home
Bed
Bed
Home
Resources
Home
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Mapping tip Map high level group first

Toolkit
Operating theatres
Processes
Scheduling The realistic building of theatre lists start in processes outside of theatre environment, essential validation of how lists are made needs to be undertaken to maintain effective and efficient operating theatres. Agreement can be made on average time per procedure to enable effective booking of theatre lists. Average time per operation can be agreed and used to assist building theatre templates.
Processes
9.00 am
Data
12.30pm
Case 1 Case 2 Case 3

Resources

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Toolkit
Operating theatres
Processes
Process steps examples
Step
Patient transported from ward Patient checked in to theatre Patient taken to anaesthetic room Anaesthetic given Patient positioned onto theatre table Surgery completed Patient taken to recovery area Patient in post op Patient taken to ward Theatre hands over patient to ward
Time per step

5 5 2 10 5 40 5 20 5 5
Processes
Data
Resources

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Toolkit
Operating theatres
Processes
Process steps examples
Step
Patient transported from ward Patient checked in to theatre Patient taken to anaesthetic room Anaesthetic given Patient positioned onto theatre table Surgery completed Patient taken to recovery area Patient in post op Patient taken to ward Theatre hands over patient to ward
Time per step

5 5 2 10 5 40 5 20 5 5
Colour code
Processes
Data
Resources

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Toolkit
Operating theatres
Processes
Build your schedule
Use graph paper with one square per minute to sequence time scales per procedure.
1 MINUTE
102 MINUTES
Processes
Data
Resources

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Toolkit
Operating theatres
Processes
Build your schedule
Transfer graph sequence timescales to chart clinic time.
9.00 am start
1.30 pm end
Processes
Data
Resources

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Toolkit
Data
Operating theatres
Core data set

Suggested Measures
Late Starts (e.g. >15mins) / Early Finishes (e.g. >60mins) / Overruns (e.g. >30mins) Example For ten Orthopaedic sessions with a scheduled start time of 8:30am the sample showed four (or 40%) started >15mins late.
Number of Major Procedures (>1hr) v Minor Procedures (<1hr) by Specialty Processes Average time in theatre by specialty / procedure Lost time due by Cancellation reasons e.g. no beds, patient unfit Data Number of patients arriving in theatre with consents not completed by week Delays Resources Monitor theatre delays for one week to agree on the top 10 reasons for delays. When this is agreed, 4 weeks data will be collected against the top 10 delays. Once 4 weeks of 10 delays have been gathered SPC charts will need to be produced. Time needs to be collected against each reason(s) per day, as the top ten offenders may not amount to the longest waste in time.

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Toolkit
Introduction
Operating theatres
Resources
Aim:
Goals of the toolkit Overview and strategy Health service team
To increase the utilisation and quality of care within operating theatres.
Change Concepts Review operating theatre utilisation (see tool kit) Scheduling Identify system to report delays daily via agreed criteria Remove delays, complexity and hand offs within administration process
Processes
Smooth process from Emergency Department / Inpatient wards to Operating Room and back to ward Review stages of Transfer from ward /Emergency Department, recovery to ward
Data
Review capacity and demand for emergency and elective theatre Review role of theatre coordinator and joint work with Pre-Operative and bed management
Resources
Review equipment turn around times via Central Sterilising Services Department and booking of equipment
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Review recovery and transfer procedures develop appropriate pull process to theatre/wards End of section
Toolkit
Introduction
Operating theatres

1.
Goals of the toolkit Overview and strategy Health service team
Operating theatre checklist Delay proforma
2.
Processes
Data
Resources

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Operating Theatre Management Toolkit

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Toolkit

A toolkit of the Patient Flow Collaborative

Department of Human Services

Diagnostics and tools

Department of Human Services

Goals of the toolkit

Diagnostics and tools

Department of Human Services

Overview and strategy

Planning patient pathways

Operating list management Trauma and emergencies

Effective use of theatre time

Diagnostics and tools

Department of Human Services

Overview and strategy

Theatre management structure

Theatre Management structure Staffing

Operating list management Trauma and emergencies

Effective use of theatre time

Diagnostics and tools

Department of Human Services

Overview and strategy

Planning patient pathways

Operating list management

Effective use of theatre time

Diagnostics and tools

Department of Human Services

Overview and strategy

Operating list management

Effective use of theatre time

Diagnostics and tools

Click to continue Page 4 of 9

Department of Human Services

Overview and strategy

Operating list management

Effective use of theatre time

Operating list management

Diagnostics and tools

Department of Human Services

Overview and strategy

Operating list management

Effective use of theatre time

Effective use of theatre time

Effective use of theatre time

Diagnostics and tools

Department of Human Services

Overview and strategy

Operating list management

Effective use of theatre time

Theatre design and operational layout

Diagnostics and tools

Department of Human Services

Overview and strategy

Trauma and emergencies

Operating list management

Effective use of theatre time

Diagnostics and tools

Department of Human Services

Overview and strategy

Operating list management Trauma and emergencies

Effective use of theatre time

Diagnostics and tools

Department of Human Services