Quantification of emergency operating theatre process performance: a systematic review of clinical studies
File(s)
Published version
Author(s)
Morton, Sarah
Manek, Roshni
Mohammadi, Narges
Skandari, Reza
Mullington, Christopher J
Type
Journal Article
Abstract
Background
Operating theatre performance is an essential component of healthcare resource optimisation. Because of its time-critical nature, emergency operating theatre performance is a problem distinct to that of elective surgery. Process performance can be quantified through the related terms: productivity, efficiency, and effectiveness. This systematic review examined the metrics used to quantify emergency operating theatre performance and the methodological quality of the associated literature.
Methods
PubMed, ISI Web of Knowledge, and Embase were searched from inception to December 2024 using Medical Subject Headings terms relating to metric, performance, and operating theatre. Studies were reviewed independently for inclusion and quality (ROBINS-I and GRADE). Only clinical studies are presented here.
Results
In total, 32 clinical studies were included, and 19 performance metrics were identified (six efficiency; 10 effectiveness; three productivity). The median (range) performance metrics per study was 4 (1–7). Frequently reported metrics were out-of-hours operating (19 studies; 59%), delay (17 studies; 53%), and utilisation (13 studies; 41%). Eleven (34%) studies were low quality and 21 (66%) were very low quality. Twenty-six (81%) studies used insufficient metrics, 30 (94%) studies used non-generalisable metrics, 29 (91%) studies did not quantify trade-off between metrics, and 16 (50%) studies had insufficient scope of investigation. Interventions evaluated included reallocating theatre time (eight studies; 25%), increasing emergency theatre capacity (eight studies; 25%), and instituting acute care surgery services (six studies; 19%).
Conclusions
Currently, there is no widely recognised framework to assess the quality of emergency theatre performance study designs. There is a tendency within clinical studies to focus on effectiveness rather than efficiency, potentially reflecting clinicians’ focus on patient outcome. Systematic biases that reduce evidence quality are common, creating uncertainty in the validity and generalisability of results. To mitigate the risk of future false economies, consensus on what constitutes best practice of theatre performance study design is required.
Systematic review protocol
PROSPERO (CRD42021295480).
Operating theatre performance is an essential component of healthcare resource optimisation. Because of its time-critical nature, emergency operating theatre performance is a problem distinct to that of elective surgery. Process performance can be quantified through the related terms: productivity, efficiency, and effectiveness. This systematic review examined the metrics used to quantify emergency operating theatre performance and the methodological quality of the associated literature.
Methods
PubMed, ISI Web of Knowledge, and Embase were searched from inception to December 2024 using Medical Subject Headings terms relating to metric, performance, and operating theatre. Studies were reviewed independently for inclusion and quality (ROBINS-I and GRADE). Only clinical studies are presented here.
Results
In total, 32 clinical studies were included, and 19 performance metrics were identified (six efficiency; 10 effectiveness; three productivity). The median (range) performance metrics per study was 4 (1–7). Frequently reported metrics were out-of-hours operating (19 studies; 59%), delay (17 studies; 53%), and utilisation (13 studies; 41%). Eleven (34%) studies were low quality and 21 (66%) were very low quality. Twenty-six (81%) studies used insufficient metrics, 30 (94%) studies used non-generalisable metrics, 29 (91%) studies did not quantify trade-off between metrics, and 16 (50%) studies had insufficient scope of investigation. Interventions evaluated included reallocating theatre time (eight studies; 25%), increasing emergency theatre capacity (eight studies; 25%), and instituting acute care surgery services (six studies; 19%).
Conclusions
Currently, there is no widely recognised framework to assess the quality of emergency theatre performance study designs. There is a tendency within clinical studies to focus on effectiveness rather than efficiency, potentially reflecting clinicians’ focus on patient outcome. Systematic biases that reduce evidence quality are common, creating uncertainty in the validity and generalisability of results. To mitigate the risk of future false economies, consensus on what constitutes best practice of theatre performance study design is required.
Systematic review protocol
PROSPERO (CRD42021295480).
Date Issued
2026-05-01
Date Acceptance
2025-12-18
Citation
British Journal of Anaesthesia, 2026, 136 (5), pp.1546-1567
ISSN
0007-0912
Publisher
Elsevier BV
Start Page
1546
End Page
1567
Journal / Book Title
British Journal of Anaesthesia
Volume
136
Issue
5
Copyright Statement
© 2026 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41638975
PII: S0007-0912(26)00008-5
Subjects
demand–capacity modelling
emergency surgery
hospital resource utilisation
operating theatre efficiency
operating theatre management
Operating Rooms
Humans
Efficiency, Organizational
Emergencies
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2026-02-04