University Department of Obstetrics and Gynaecology, Royal Free Hospital, Hampstead, UK.
Int J Health Plann Manage. 2009 Jul-Sep;24(3):225-32. doi: 10.1002/hpm.966.
To determine reasons for delay during elective operating lists and suggest solutions.
Prospective observational study.
A large under-graduate teaching hospital.
Fifty-five consecutive women undergoing elective gynaecological surgery under general anaesthesia.
Every time point of individual patient's passage through the operating theatre (patients sent for, arrival in the anaesthetic room, general anaesthetic commenced, transfer to the operating theatre, surgery started, surgery completed, anaesthetic reversed, patient taken to recovery area) was documented.
Time intervals between the various time points with particular reference to wait by the anaesthetist and surgeon between cases.
We monitored 55 operations carried out during 22 operating lists. Apart from the surgery itself (median 81 min per procedure), the longest interval was the time taken to get patients into the anaesthetic room from the ward (median 20 min). Although patients waited a median of 10 min before the start of anaesthesia, if the first procedure on the list was excluded, the anaesthetist was waiting for the patient to arrive in the anaesthetic room in 13/30 (43%) cases, wasting a median of 7 min per case. The surgeon had to wait a median of 22.5 min between operations.
Considerable operating theatre time is wasted while patients are transferred to and from the operating theatre resulting in both anaesthetists and surgeons having to wait between patients in a high proportion of cases, averaging 1 h during a 4 h operating list. Surgery could be made more time efficient by ensuring that patients arrive in the operating theatre complex early enough (to reduce time wasted for anaesthetists and surgeons), and by having two anaesthetists available at the end of surgery, one to reverse the anaesthetic while the other starts the next induction (to reduce time waste for the surgeon), coupled to adequate recovery area capacity.
确定择期手术清单中延迟的原因并提出解决方案。
前瞻性观察研究。
一家大型本科教学医院。
55 名连续接受全身麻醉下妇科手术的女性。
记录每位患者通过手术室的各个时间点（患者被送往、到达麻醉室、开始全身麻醉、转移到手术室、手术开始、手术完成、麻醉逆转、患者送往恢复区）。
各时间点之间的时间间隔，特别是麻醉师和外科医生在手术之间的等待时间。
我们监测了在 22 个手术清单中进行的 55 次手术。除了手术本身（每次手术中位数为 81 分钟），最长的时间间隔是将患者从病房转移到麻醉室的时间（中位数为 20 分钟）。尽管患者在开始麻醉前等待了中位数为 10 分钟，但如果排除第一个手术，麻醉师在 30 个手术中的 13 个（43%）情况下等待患者到达麻醉室，浪费了中位数为 7 分钟/例。外科医生在手术之间必须等待中位数为 22.5 分钟。
患者在手术室之间转移时会浪费大量手术室时间，导致麻醉师和外科医生在很大比例的情况下都需要等待，在 4 小时的手术清单中平均浪费 1 小时。通过确保患者足够早地到达手术室（减少麻醉师和外科医生的浪费时间），并在手术结束时配备两名麻醉师，一名在麻醉逆转时开始下一次诱导，另一名开始下一次诱导（减少外科医生的浪费时间），再加上足够的恢复区容量，手术可以更有效地利用时间。
