Strategies to Improve Start Time in the Operating Theatre: a Systematic Review.

Operating theatres represent a significant cost burden for healthcare providers around the world. Theatre start time is widely acknowledged as an important target for efficiency savings. However, there is uncertainty surrounding the effectiveness of strategies to improve start time, and questions regarding the barriers to their implementation. We conducted a systematic review of bibliographic databases to identify primary research papers assessing the effect of interventions on theatre start time. Two hundred and nine papers were found from electronic literature search with 14 being included in the final review. Financial incentives, educational approaches, system-based techniques, communication, the 'golden patient' initiative and 'the productive operating theatre' scheme have all been shown to improve start time. However, questions remain over which is the most effective, the longevity of their effects and whether the results can be extrapolated beyond the context in which they were studied. We summarise the key approaches reported in the literature and identify areas for future research. This is of use to clinicians and hospital managers seeking to improve efficiency and achieve cost savings.