Time and motion studies of National Health Service cataract theatre lists to determine strategies to improve efficiency
File(s)
Accepted version
Author(s)
Roberts, Harry W
Myerscough, James
Borsci, Simone
Ni, Melody
O'Brart, David PS
Type
Journal Article
Abstract
Aim To provide a quantitative assessment of cataract theatre lists focusing on productivity and staffing levels/tasks using time and motion studies.
Methods National Health Service (NHS) cataract theatre lists were prospectively observed in five different institutions (four NHS hospitals and one private hospital). Individual tasks and their timings of every member of staff were recorded. Multiple linear regression analyses were performed to investigate possible associations between individual timings and tasks.
Results 140 operations were studied over 18 theatre sessions. The median number of scheduled cataract operations was 7 (range: 5–14). The average duration of an operation was 10.3 min±(SD 4.11 min). The average time to complete one case including patient turnaround was 19.97 min (SD 8.77 min). The proportion of the surgeons’ time occupied on total duties or operating ranged from 65.2% to 76.1% and from 42.4% to 56.7%, respectively. The correlations of the surgical time to patient time in theatre was R2=0.95. A multiple linear regression model found a significant association (F(3,111)=32.86, P<0.001) with R2=0.47 between the duration of one operation and the number of allied healthcare professionals (AHPs), the number of AHP key tasks and the time taken to perform these key tasks by the AHPs.
Conclusions Significant variability in the number of cases performed and the efficiency of patient flow were found between different institutions. Time and motion studies identified requirements for high-volume models and factors relating to performance. Supporting the surgeon with sufficient AHPs and tasks performed by AHPs could improve surgical efficiency up to approximately double productivity over conventional theatre models.
Methods National Health Service (NHS) cataract theatre lists were prospectively observed in five different institutions (four NHS hospitals and one private hospital). Individual tasks and their timings of every member of staff were recorded. Multiple linear regression analyses were performed to investigate possible associations between individual timings and tasks.
Results 140 operations were studied over 18 theatre sessions. The median number of scheduled cataract operations was 7 (range: 5–14). The average duration of an operation was 10.3 min±(SD 4.11 min). The average time to complete one case including patient turnaround was 19.97 min (SD 8.77 min). The proportion of the surgeons’ time occupied on total duties or operating ranged from 65.2% to 76.1% and from 42.4% to 56.7%, respectively. The correlations of the surgical time to patient time in theatre was R2=0.95. A multiple linear regression model found a significant association (F(3,111)=32.86, P<0.001) with R2=0.47 between the duration of one operation and the number of allied healthcare professionals (AHPs), the number of AHP key tasks and the time taken to perform these key tasks by the AHPs.
Conclusions Significant variability in the number of cases performed and the efficiency of patient flow were found between different institutions. Time and motion studies identified requirements for high-volume models and factors relating to performance. Supporting the surgeon with sufficient AHPs and tasks performed by AHPs could improve surgical efficiency up to approximately double productivity over conventional theatre models.
Date Issued
2018-09-01
Date Acceptance
2017-11-04
Citation
British Journal of Ophthalmology, 2018, 102 (9), pp.1259-1267
ISSN
0007-1161
Publisher
BMJ Publishing Group
Start Page
1259
End Page
1267
Journal / Book Title
British Journal of Ophthalmology
Volume
102
Issue
9
Copyright Statement
© 2018 The Author(s). This article has been accepted for publication in British Journal of Ophthalmology following peer review. The definitive copyedited, typeset version [Roberts HW, Myerscough J, Borsci S, et al Time and motion studies of National Health Service cataract theatre lists to determine strategies to improve efficiency British Journal of Ophthalmology 2018;102:1259-1267.] is available online at: http://dx.doi.org/10.1136/bjophthalmol-2017-310452.
Sponsor
Guys & St Thomas NHS Foundation Trust
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000445109700016&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
WSSS_P64463
Subjects
Science & Technology
Life Sciences & Biomedicine
Ophthalmology
SURGERY
OUTCOMES
Publication Status
Published
Date Publish Online
2017-11-24