Analysis of Orthopeadic Theatre Time Utilization

Analysis of Orthopeadic bailiwick of carrying into actions Time UtilizationANALYSIS OF ORTHOPEADIC THEATRE measure UTILIZATION AT KENYATTA NATIONAL HOSPITALTrauma is the leading causes of portal in Kenyatta National Hospital and often these endurings require surgery. The trauma shoot unpredictability usu solelyy mismatches demand and supply of the hospital thus session challenge for systems improvement and streamlining.Utilization is define as the ratio of date that an as gear up is employ, against its capacity.For uniformity among the OR team, it is extremely important to developing a precise definition of turnaround sequence. For the purpose of this paper, turnaround judgment of conviction is defined as the judgment of conviction amongst incision close of longanimous n and incision open of patient n+1. This definition captures the surgeons, anaesthetist and suck in perspective of turnaround time and allows us to see the encumber among the most expensive value- added times in the planetary house.Previous larn from KNH reported high rate of cancellation of nonappointive list on the sidereal day of surgeries (20.6%)1. One of the causes attributed to these agrees was in potent role of OR time, mainly impu sidestep to delay in scratch time and long turnaround time inwardly the OR. It was noted that 70.9% of non clinical cancellation was due to list overrun/lack of time. It was exchangeablewise the leading cause of cancellation in KNH at (43.8%). Three specialty were determine to have recorded the highest cancellation rate were Cardiothoracic surgeries 38%, Neurosurgeries 37.8% and Orthopedic surgeries 32.6%1. Cancellation generally increases wait list and the risk of further cancellation, which may cause patient dissatisfaction and via media patients safety2.Poor scheduling of operations can military issue in cancellation of operation which is courtly to both the patient and the hospital3. With the escalating cost of healthc ato mic number 18, caliber of care fails to meet expectation of our patients and so, the health care organization should come along on strategies to improve quality while reducing cost of data track hospitals.The faculty of operational room can be measured in variety of ways4. cleverness is defined in term of ability to submit useable time into earning58. Computer simulation and mathematical models, both of which basically idealizations that the practical capacity for OR to be between 80-90%9.JustificationTheatre complex is a high cost department with the hospital and therefore considerable resources are wasted if operating room if not used effectively. Improving the performance of operating room is key to achieving shorter waiting time for surgery, reducing cancellation for operations and more so achieving the implementation of booking of elective surgery in our hospital. Increased utilization of operating room improves patients issue and reduces the waiting list time. Improv ing home utilization would lead to a reduction in cost recovery from each patients10. 4 in their take up in due south African concluded that private operation field of operation utilization rates were higher than public operation theatres due to commercial reputation of private healthcare and absent consequent cost drivers in public health sector10. Utilization rate in South Africa was found to be 48% which was significantly lower than the globally remove mark of between 70-80%4. 11 concluded that the delay in set outing list, under schedule, interruption due to emergency surgeries, administrative reasons, induction of anaesthesia and recovery police are the main factor that account for inefficient use of operating room facilities in India hospitalsOperating room utilization rate is usually an indicator used in measuring efficiency in use of hospital resources. It is argued that high utilization is cost effective and improves quality of care10,1215.Brief Description of KNH M ain Theatre KNH Main theatre is located in the first floor of the tower closedown contiguous to Critical Care building block (CCU), Renal and Burns Unit. It has twelve operating rooms out of which two are allocated to Prime Care subject matter angiotensin converting enzyme is dedicated for emergency surgeries 24 hours a day. The remaining cardinal are allocated to different specialty in a week. The specialties are planetary surgery, Urology surgery, Maxillofacial surgery, ENT surgery, Pediatrics surgery, Plastic surgery, Ophthalmology surgery, Orthopedic surgery, Cardiothoracic surgery, Neurosurgical and Obstetrics and gynaecology surgery.Within the OR the following equipments are found, Operating table in the center of the room, Operating lights directly over the table to provide agleam light during surgery, Anaesthesia machine is at the head of the operating table equipped with Electronic monitor machine which records the heart rate and respiratory rate by adhesive patche s called chest leads placed on patients chest, it has withal the Pulse oximeter which is attached to the patients palpate with an elastic band aid. Pulse oximeter measures the enumerate of oxygen contained in the blood, an automatize blood force per unit line of business measuring machine that automatically inflates the blood pressure cuff on patients arm continuously save blood pressure, there is the diathermy machine which uses high frequency electrical signals to fire blood vessels and cut through tissue with a minimal amount of bleeding. Other specialized machines may be brought in depending on the nature of surgery.In a week there are 45 theatre space slot allocated to different specialty, out of which orthopedic surgeries have 12 slots and the remaining 33 slot are allocated among the remaining 10 specialty. The orthopedic department is located on the sixth floor of the tower block and has four wards namely 6A, 6B, 6C and 6D. hospital ward 6B serves as a joint admiss ion charge for all pediatric cases from 6A, 6C and 6D. for each one ward has four days in a week to do the elective surgeries.Theatre procedureEach ward is expected to submit its operation list to main theatre reception before 1500 hours on the day before its assigned operation day. In the evening before the surgery, anaesthetists visit the wards to do a pre-anesthetic measure outment on patients who had been scheduled for surgery. They are expected to re-assure these patients, assess their fitness for surgery, and also confirm the necessary investigation are do which they document in the pre-anesthetic memorize list.On the day of surgery porters are sent to the ward to bring the patients who are then received by a designated theatre nurse at the receiving area, the Receiving Area nurse check to confirm the identity of the patient, see that consent for the surgery had been given and all necessary investigation have been done. Thereafter, the patient is wheeled to waiting bespea k where he/she is kept on-hold until the theatre room is ready. All other procedures like intravenous access and induction of anaesthesia are done in theatre. After surgery, the patient is taken to Post Anesthesia Care Unit (PACU) while the operating room is cleaned in preparation for the next patient.Economic considerations also suggest that it is desirable to keep operating rooms fully used. Thus, it is imperative that areas of time wastage in the theatre time flow be recognized and their causes identified. This give assist theatre managers take necessary steps to correct the problem14. clinicalTo identify areas of, and causes of operating room time delay, and suggest solution ground on the identified deficiencies.Operating theatre represents an area of considerable pulmonary tuberculosis in a hospital budget. Consequently, hospital administrators are so have-to doe with with maximizing utilization of OR. This can only be made achievable by knowing how much time is spent on w hich natural process and there by identify the factors resulting in under utilization of OR16.StaffingKNH theatre complex is being managed by Assistant Chief Nurse (ACN) with the help oneself of Administrative Officer. The two are answerable to the Head of Department (HOD) Theatre, TSSU and CSSD. The round within each OR includes Surgeons, Anesthetist, 1- circulating nurse , 1- scrub nurse and 1- theatre sterile assistant (TSA). The general theatre activities are overseen by a Theatre Users Committee (TUC), with HOD as the chairperson. Other members are from Nursing, Surgery, Anaesthesia, boldness and Technical departments.Data CollectionI lead survey the clock of events in the Orthopedic OR using their elective operating lists available from Monday to Friday at theatre front office desk for a period of one month. I ordain use a designed proforma establish on established operating theatre process steps to record the following longanimous sent-for (PS) Time when porter leave R/A to the ward for the patientPatient available (PA) Time the patient arrives at theatre R/APatient in room (PIR) time when patient enters ORAnesthesia/Induction start time (AIT) time induction of anesthesia startsSurgery start time (ST) time cleaning of surgical areaSurgery finish (SF) time dressing is put on the incision sitePatient out OR (POR) Time at which patient leaves the ORFrom the above times, I will derive the followingWard to theatre transfer interval the interval between PS and PA (b-a). This interval is prolonged when it is greater than 20 minutes.R/A waiting time It is the interval between patient available (PA) and when patient is transferred to OR (c-b). It is prolonged if it is greater than 10 minutes.Pre-anesthetic waiting time the difference between patients in room (PIR) and anesthesia/induction start time (AIT) (d-c). It is prolonged when it is greater than 20 minutes.Anaesthesia admission time (AAT) the interval between AIT and ST (e-d) and it is prolonged when it is greater than 20 minutes.Surgery while the interval between ST and SF (f-e).Anesthesia reversal time (ART) the interval between SF and POR (g-f)Turnaround time (TAT) the interval between incision close of patient n and incision open of patient n+1.There will be a one week pilot study to set the cut-off point for the intervals between normal and delayed time. This will be based on the mean time observed in the pilot study and for convenience it will be rounded-up to the nearest number divisible by five. In case of delay outside theatre the officer voluminous will be interviewed to determine the cause of the delay. However, delays that occures in the theatre will be observed directly by the research assistant cream the proforma.The data was entered into SPSS 11.5 which was used to calculate the time intervals and for statistical analysisEfficiency means the management of theatre time, costs resources and staff to undertake as many procedures as possible within given levels of resources, or doing the aforesaid(prenominal) number of procedures using a lesser amount of resources.