Causes of elective surgery cancellation and theatre throughput efficiency in an Australian urology unit

Objective: To evaluate our unit’s theatre throughput efficiency, to identify where inefficiencies existed and consequently where the greatest improvement might be made. To identify the causes of day of surgery cancellations and how they might be avoided. . Patients and Methods: A prospective audit of theatre utilisation was undertaken over a 6 month period between 05/02//2013 and 02/08/2013 at Ipswich General Hospital, QLD, Australia. Times collected were: time of patient arrival in anaesthetic bay, start time of operative procedure, end time of operative procedure, and time of patient leaving theatre. The causative factors for any delays or day of surgery cancellations were identified and recorded where possible. Results: In the six month period 26,850 sessional minutes were available for elective operating over 100 operating sessions. 304 elective cases were performed, split between 21 major and 283 minor procedures. The sessions ran overtime a cumulative 2114 minutes. Total non-operative minutes totalled 13,209 (50.3% of all available time), split between late starts 499 minutes (1.8%), early list finishes 1894 minutes (7.05%), changeover time 1869 minutes (6.9%) and anaesthetic time, 8974 minutes (33.4%). Actual operating time only compromised 50.7% of all available elective operating session time (13,614 minutes). Theatre utilisation was 91.8%. 51 procedures were cancelled on the day of surgery during the audit period, representing 14.3% of all scheduled procedures. The most common reason for cancellation was lack of surgical fitness, followed by inadequate operative time. Conclusion: A significant proportion of all elective operative time was consumed by non-operative minutes. Inefficiencies existed in turnover of patients as well as over as well as underbooking of patients on elective lists. An excessive number of cases were cancelled on the day of surgery, wasting valuable operative time. A multi-parametric approach must be taken to improve operation list utilisation.