Actions before and after the actual surgery in theatres will impact on theatre productivity. Inefficiencies already identified pre-Covid were amplified during the pandemic. Ensuring hospitals reset their surgical pathways and processes, while maintaining capacity to teach and train, is vital to improve theatre productivity and efficiency. It will enable more efficient use of the sessions we can currently staff and run and will provide a firm base on which to increase our estate usage.
Improvements to theatre productivity require a full team effort and should not be seen as the sole responsibility of theatres. Input and action are required across the surgical and perioperative pathways and providers should ensure this work is taken forward by relevant teams working collaboratively and in an aligned way with dedicated clinical ownership and executive support. Improving productivity means delivering as much clinical value for patients as possible with the resources we have, while maintaining safety and improving staff engagement and morale. A whole provider approach is needed with all clinical, operational and theatre teams considering how the elements within their control contribute to the overall value of surgical services and care.
Some key points with regard to theatre efficiencies is its equipment availability and user training for specialist equipment.
Having clear, standardised processes to manage theatre preparation should reduce late starts; timely starts sets things up for a productive day. Processes should be in place to ensure theatre teams replenish stocks at the end of each day, ready for the next day (including drugs and fluids). Following theatre cleaning, night teams should use the equipment prepared by the day shift, and the individual anaesthetic and surgeon preference cards, to set up equipment for the next day’s identified golden patient. For teams without a night shift, all the equipment should be ready for the day shift to bring into the clean theatre at the start of the next day shift.
Prepared instrumentation and equipment should be re-confirmed in the morning, before any team brief including, for example (not exhaustive), instrumentation by case; equipment, including operating table; positioning aids; anaesthetic equipment (to include block equipment/trolley/pumps); fluids and drugs.
Effective communication: Optimising theatre flows to deliver the most value for patients hinges on the effectiveness of the whole team. Appropriate systems should be in place to support co-ordinating theatres ensuring that everyone involved is well informed about all patients, procedures, equipment requirements and planned timings.
Consider recruitment, training and retention needs, including specific equipment/ specialty training requirements.
The full guide is here: https://www.england.nhs.uk/long-read/theatres-surgery-and-perioperative-care/
