Negash Samuel, Anberber Endale, Ayele Blen, Ashebir Zeweter, Abate Ananya, Bitew Senait, Derbew Miliard, Weiser Thomas G, Starr Nichole, Mammo Tihitena Negussie
Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Anesthesia, Addis Ababa University, Addis Ababa, Ethiopia.
Patient Saf Surg. 2022 Jan 7;16(1):3. doi: 10.1186/s13037-021-00314-5.
The operating room (OR) is one of the most expensive areas of a hospital, requiring large capital and recurring investments, and necessitating efficient throughput to reduce costs per patient encounter. On top of increasing costs, inefficient utilization of operating rooms results in prolonged waiting lists, high rate of cancellation, frustration of OR personnel as well as increased anxiety that negatively impacts the health of patients. This problem is magnified in developing countries, where there is a high unmet surgical need. However, no system currently exists to assess operating room utilization in Ethiopia.
A prospective study was conducted over a period of 3 months (May 1 to July 31, 2019) in a tertiary hospital. Surgical case start time, end time, room turnover time, cancellations and reason for cancellation were observed to evaluate the efficiency of eight operating rooms.
A total of 933 elective procedures were observed during the study period. Of these, 246 were cancelled, yielding a cancellation rate of 35.8%. The most common reasons for cancellation were related to lack of OR time and patient preparation (8.7% and 7.7% respectively). Shortage of facilities (instrument, blood, ICU bed) were causes of cancelation in 7.7%. Start time was delayed in 93.4% (mean 8:56 am ± 52 min) of cases. Last case completion time was early in 47.9% and delayed in 20.6% (mean 2:54 pm ± 156 min). Turnover time was prolonged in 34.5% (mean 25 min ± 49 min). Total operating room utilization ranged from 10.5% to 174%. Operating rooms were underutilized in 42.7% while overutilization was found in 14.6%.
We found a high cancellation rate, most attributable to late start times leading to delays for the remainder of cases, and lack of preoperative patient preparation. In a setting with a high unmet burden of surgical disease, OR efficiency must be maximized with improved patient evaluation workflows, adequate OR staffing and commitment to punctual start times. We recommend future quality improvement projects focusing on these areas to increase OR efficiency.
手术室是医院中成本最高的区域之一，需要大量的资金投入和持续投资，并且需要高效的周转以降低每位患者的诊疗成本。除了成本增加外，手术室利用效率低下还会导致等候名单延长、高取消率、手术室工作人员的挫败感以及患者焦虑情绪增加——这些都会对患者的健康产生负面影响。在外科需求未得到满足的发展中国家，这个问题更为严重。然而，埃塞俄比亚目前尚无评估手术室利用情况的系统。
在一家三级医院进行了为期3个月（2019年5月1日至7月31日）的前瞻性研究。观察手术病例的开始时间、结束时间、手术室周转时间、取消情况及取消原因，以评估8间手术室的效率。
研究期间共观察了933例择期手术。其中，246例被取消，取消率为35.8%。最常见的取消原因与手术室时间不足和患者准备不足有关（分别为8.7%和7.7%）。7.7%的取消原因是设施短缺（器械、血液、重症监护病床）。93.4%的病例开始时间延迟（平均上午8:56 ± 52分钟）。最后一例手术完成时间提前的占47.9%，延迟的占20.6%（平均下午2:54 ± 156分钟）。周转时间延长的占34.5%（平均25分钟 ± 49分钟）。手术室总利用率在10.5%至174%之间。42.7%的手术室利用不足，14.6%的手术室利用过度。
我们发现取消率很高，主要归因于开始时间过晚导致其余病例延误，以及术前患者准备不足。在外科疾病负担未得到满足的情况下，必须通过改进患者评估流程、配备充足的手术室工作人员以及保证准时开始手术，来最大限度地提高手术室效率。我们建议未来的质量改进项目聚焦于这些领域，以提高手术室效率。
