How time flies: a prospective analysis of theatre efficiency during elective gynaecology lists

The aim of this study was to assess the time patients spend at the various stages of the surgical journey and identifying factors that lead to “bottlenecks”. A prospective, observational study of 70 patients over 23 consecutive elective gynaecology lists. Timelines of patients' surgical journey were recorded and various outcomes such as room turnover and patient turnaround intervals calculated. Of the 70 patients (23 major and 47 intermediate), 32 were managed by one anaesthetist and 38 cases by two. The mean arrival in the operating theatre—knife-to-skin interval for major cases was significantly longer than intermediate (17.9 vs. 12.05 min, p = 0.001), but there were no statistically significant differences in other time intervals between major/intermediate cases. The mean patient turnaround and room turnover times for the 70 cases were 44.2 and 60.0 min, respectively, and only 60.3% of theatre time was actually spent on surgery. Having two anaesthetists reduced the arrival in the operating theatre—knife-to-skin interval by a mean of 4 min (11.4 vs. 16.63 min, p = 0.045) but had no positive effect on other variables. Prolonged patient turnover leads to significant delay, resulting in impaired efficiency. Factors in individual cases which affected patient turnaround time include inadequate preparation of equipment and delays in preparing the patient before anaesthesia. Deploying extra personal at the appropriate time can lead to efficiency savings but adequate planning of both schedules and equipment will lead to the best outcomes.