Is theatre utilization a valid performance indicator for NHS operating theatres?

BACKGROUND: Utilization is used as the principal marker of theatre performance in the NHS. This study investigated its validity as: a managerial tool, an inter-Trust indicator of efficient theatre use and as a marker of service performance for surgeons. METHODS: A multivariate linear regression model was constructed using theatre data comprising all elective general surgical operating lists performed at a NHS Teaching hospital over a seven-year period. The model investigated the influence of: operating list size, individual surgeons and anaesthetists, late-starts, overruns, session type and theatre suite on utilization (%). RESULTS: 7,283 inpatient and 8,314 day case operations were performed on 3,234 and 2,092 lists respectively. Multivariate analysis demonstrated that the strongest independent predictors of list utilization were the size of the operating list (p < 0.01) and whether the list overran (p < 0.01). Surgeons differed in their ability to influence utilization. Their overall influence upon utilization was however small. CONCLUSION: Theatre utilization broadly reflects the surgical volume successfully admitted and operated on elective lists. At extreme values it can expose administrative process failure within individual Trusts but probably lacks specificity for meaningful use as an inter-Trust theatre performance indicator. Unadjusted utilization rates fail to reflect the service performance of surgeons, as their ability to influence it is small.

We still need to operate at night!

INTRODUCTION: In the past the National Confidential Enquiry into Peri-operative deaths (NCEPOD) have advocated a reduction in non-essential night-time operating in NHS hospitals. In this study a retrospective analysis of the emergency general surgical operative workload at a London Teaching centre was performed. METHODS: All general surgical and vascular emergency operations recorded prospectively on the theatre database between 1997 and 2004 were included in the study. Operations were categorised according to whether they commenced during the daytime(08:01-18:00 hours), evening(18:01-00:00 hours) or night-time(00:01-08:00 hours). The procedure type and grade of the participating surgical personnel were also recorded. Bivariate correlation was used to analyse changing trends in the emergency workload. RESULTS: In total 5,316 emergency operations were performed over the study period. The numbers of daytime, evening and night-time emergency procedures performed were 2,963(55.7%), 1,832(34.5%), and 521(9.8%) respectively. Laparotomies and complex vascular procedures collectively accounted for half of all cases performed after midnight whereas they represented only 30% of the combined daytime and evening emergency workload. Thirty-two percent (n = 166) of all night-time operations were supervised or performed by a consultant surgeon. The annual volume of emergency cases performed increased significantly throughout the study period. Enhanced daytime (r = 0.741, p < 0.01) and evening (r = 0.548, p < 0.01) operating absorbed this increase in workload. There was no significant change in the absolute number of cases performed at night but the proportion of the emergency workload that took place after midnight decreased significantly throughout the study (r = -0.742, p < 0.01). CONCLUSION: A small but consistent volume of complex cases require emergency surgery after midnight. Provision of an emergency general surgical service must incorporate this need.

Bridging the health gap in Uganda: the surgical role of the clinical officer.

INTRODUCTION: A scarcity of trained medical personnel impedes Uganda's ability to deliver healthcare effectively. The role of the Clinical Officer (CO) was established to assist the provision of primary healthcare to rural communities. METHODS: Twenty COs, attending a clinical course, responded to a structured questionnaire to determine their local investigative resources, the cases encountered by them in the two-week period preceding the course and the surgical and obstetric procedures that they felt able to perform. RESULTS: The majority of respondents did not have access to biochemical or radiological investigations. Fifty-five percent had access to basic haematology and urine microscopy. The majority of the case-mix encountered by the COs was medical (median 60 %) but they also encountered a proportion of surgical (median 12.5 %) and obstetric cases (median 15 %). COs felt confident in performing routine obstetric procedures as well as offering basic wound and surgical infection management. CONCLUSION: COs already provide a vital role in the delivery of healthcare in Uganda. Their surgical role could be augmented through further education and training. This might help to bridge the gap between overwhelming demand for medical services and a scant supply of trained personnel.