Gold Coast Hospital and Health Service implemented changes to improve operating theatre efficiency in response to recommendations from a Queensland Audit Office report. Key changes included implementing governance structures for theatre scheduling, process mapping the patient journey to identify delays, and staff workshops to prioritize issues. Results showed improvements in turnaround times between cases and rates of first cases beginning on time. Further opportunities were identified to reduce cancelled surgeries and better evaluate the new theatre management information system.

1. Gold Coast Hospital and Health Service
Improving Operating Theatre Efficiency and responding
to QAO recommendations
Heidi Weber – Nurse Unit Manager
Perioperative Services
Jennifer Kosiol Nursing Director Perioperative, Critical Care & Trauma Services
Gold Coast University Hospital

2. Increasing pressure to meet NEST within a fiscal environment led to a need for Gold
Coast Health to find internal efficiencies within the Operating Theatre and create new
service delivery approaches.
Gold Coast Hospital and Health Service
Population of 568,000 | Budget of $1.3b
33,000 visitors every day | 28,000 operations per annum
750 bed tertiary facility – Gold Coast University Hospital
364 bed community facility – Robina Hospital
12 specialities, including Cardiac, Neurosurgical and Level 1 Trauma

3. QAO Report
§ 19 April 2016 QLD Audit Office tabled the Queensland
Public Hospital Operating Theatre Efficiency Report no 15.
§ Focused on emergency and elective surgical services provided
through 39 public hospitals across QLD.
§ Delivered 10 recommendations aimed at improving theatre
utilisation and contributing to driving patient safety, quality
improvement and clinical improvement across the health service.

4. Recommendations
10 recommendations
DoH and HHS
/

5. GCHHS results
§ GCUH
§ Lowest principal referral hospital for theatre
utilisation performance across peer group = 72.8%
(better practice benchmark 85%)
§ Lowest performance of 1st case wheeled into theatre
by scheduled start time = 28.2% (82% GCHHS)
(hospitals that aim to commence anaesthetic procedure by scheduled start time
will show lower performance)
§ Robina
§ High peer group A hospital for theatre utilisation
across peer group = 76.5%
§ Low performance of 1st case wheeled into theatre by
scheduled start time = 22.6%

6. Theatre Data
Management Information System (MIS)
§ A framework for demand and capacity management
§ Treating patients equitably within clinically appropriate timeframes
§ Theatre Schedule Monitor and Utilisation Tracker.
§ Maximum utilisation of session time to treat maximum number of patients
§ Minimising cancellations by effective scheduling
§ Number of elective theatre sessions moderated to meet NEST
© 2016 Confidential Draft Discussion Document 6

7. Session allocation v Waitlist demand

8. Orthopaedic wait list Cat 1-3 next 11months

9. Emergency operating time in Elective Sessions

10. Operating Theatre Performance
Efficiency KPIs
• Utilisation : wheels in first
patient, wheels out last patient for
the session 80%
• First Case On time start 85%
•Turn around time between cases
15mins
•Patient cancellations <2%

11. Theatre efficiency is influenced by:

12. Changing our culture
§ https://www.youtube.com/watch?v=y-PvBo75PDo

14. Birth of the Project
§ Governance structures
§ Process Map
§ Staff workshop

15. Governance
§ Operating Theatre Management Committee
§ Roles and Responsibilities defined
§ Bi-weekly Theatre Scheduling
Meeting
§ Session Allocation and Scheduling Guideline

16. Process Mapping

17. Theatre Planning
• Using TPOT principles
• 2nd Weekly workshops
• Action plans developed
• Performance Board
Displayed in theatre

19. Priorities from Workshops
§ To have helpful staff
§ To be informed of relevant equipment
§ To have a team focus not an individual focus
§ Improve staff morale
§ Improve planning ahead for avoidable delays
§ Improve communication in the theatres

20. Identified Barriers and Enablers
Barrier Enabler
Nursing staff not ready to transfer
patient to the anaes bay OSO takes patient to bay
Late changes (e.g. day of surgery) to
order of the list : No changes to order of list sfter
3pm day before surgery
Equipment/instrument clashes
Identifying equipment clashes at
weekly schedule meeting
Set up cards not correct
Review of set up cards by
specialty CNs
OSO's do not know equipment and
theatre set up
Improving knowledge deficit of
OSOs re equipment through
inservice education
Patients not ready due to Staffing
constraints in DSU 6am starters in DSU
Theatre not ready for surgery More 7am scrub/scout starters
No communication of requirements
for surgery on the day Team brief
Not sure if we are improving or how
we are going
Performance board visible for all
staff and first case on time start
graphs in theatre for team
visibility

21. Implementation - Team Brief
• Create a calmer working environment for staff and patients
• Avoid errors and prevent mistakes from occurring or causing
harm to patients
• Reduce hierarchies and give everyone an equal voice
• Create a shared plan for the list to reduce the opportunity for
surprises
• Review the list and identify any issues that can be removed

22. Everyone has a role in a team

23. Remember in health care the driver is the patient

24. Results so far…..
§ We can review the results of the changes made.
§ Are we seeing the results we anticipated?

26. All Cardiac Dental ENT Max Fac General Gynae Neuro Eyes Ortho
Obstetri
cs
Paed Plastics Urology Vascular
Jan 18 28 17 25 29 26 17 28 14 23 16 13 13 13 20
Feb 18 26 15 24 13 17 20 26 12 23 12 19 23 14 31
March 17 30 17 15 14 20 20 30 10 21 19 15 16 13 27
April 19 24 19 22 17 24 18 25 11 25 15 23 25 13 18
May 19 24 19 21 18 24 18 25 11 26 15 20 25 13 18
June 18 27 15 20 18 23 16 33 9 24 16 17 18 12 18
0
5
10
15
20
25
30
35
Turn Around Times

27. 0
5
10
15
20
25
Minutes
9-Jan 16-Jan23-Jan30-Jan 6-Feb 13-Feb20-Feb27-Feb6-Mar
13-
Mar
20-
Mar
27-
Mar
3-Apr 10-Apr17-Apr24-Apr1-May8-May
15-
May
22-
May
29-
May
5-Jun 12-Jun19-Jun26-Jun
All 20 18 20 19 13 14 15 14 14 10 13 9 12 12 8 7 12 11 16 11 15 15 14 12 14
All - Average First Case On Time Starts - AM session

28. Future Opportunities
§ DOS cancellation project
§ MIS evaluation
§ Ongoing monitoring of changes to practice

29. Key achievements
§ Commencement of revised Operating Theatre Schedule meeting
§ Operating Theatre Strategic Planning Meeting
§ Team Briefs rolled out
§ Staff Workshops and Action plans developed to improve team work and communication, first case on time starts,
turn around times
§ Consistent teams – rotations, specialisation
§ Completed process map for the patient journey with highlighted potential delays in the journey that are able to be
addressed – action plans written
§ ORMIS definitions – time out before procedure start
§ Theatre List changes cut offs 3pm day before surgery
§ Process for OSO’s bringing pts to theatres
§ Process mapping of perioperative patient journey with NUMs, CNs. Delays and barriers identified. Actions
identified to enable on time starts. 6am start in SAU to facilitate admissions
§ Poster for key time stamps with escalation processes via first case on time start
§ Implementation of the recommendations in the QLD Health Theatre efficiency guidelines
New or revised procedures
§ Administration of Operating theatre sessions scheduling - endorsed
§ Requests for Additional Theatre time – endorsed
§ Commencement of new surgeons - endorsed
§ First cast on time starts WI including escalation procedures - endorsed
§ Operating theatre emergency surgery and management - endorsed

30. Thank you