ORTHOPEDIC (THEATRE 5) AUDIT

AIM

To assess average end-time for theatre 5 and to identify any correctable reasons for
delays and overruns.

BACKGROUND:

The Emergency theatre audit showed that overruns of elective lists were one of the
top three reasons for emergency theatre delays.

Overruns tend to exaggerate theatre usage by any one team but leads to delays in
other areas. NHS Management Executive recommends ≥90% utilization of planned
theatre time (as a key performance indicator)

Major causes of theatre overruns include poor theatre efficiency with long turnover
time and late start, and poor scheduling (poor averaging for length of surgery and
anaesthetic time)

DEFINITIONS (with recommended figures):

Theatre utilization: How much time OT is occupied by patients vs total available

time (80%)

First case start on time (95% within 10 mins i.e. 8:10am)

Overruns: number of lists finished after scheduled time i.e. 4pm

Underruns: this is calculated based on case mix and average case time e.g. if average
case time is approximately 2 hours then completion of the list with > 2hours left of
scheduled time is considered an underrun.

Day of surgery cancellations (DOS): % of elective cases cancelled on the day of

surgery (<5% at tertiary hospitals due to higher risk patients, <2% at other
hospitals)

Start time refers to the time the patient is on the table before the start of anaesthetic
i.e. when the anaesthetist takes charge of the patient in preparation for anaesthesia

End time refers to the time the anaesthetist has handed over the patient to recovery
room staff and is free to start another case.
Between start time and end time involves anaesthetic induction, positioning,
surgical start and end and anaesthetic end. This is the operating time.

DURATION: 4 WEEKS

TEAM MEMBERS

Dr. Tameem Mohammed (team leader)

Dr. Chantal Gosine
ORTHOPEDIC (THEATRE 5) AUDIT

AVERAGE CASE TIME

*data taken from 1st June- 8th Sept 2017. Average time rounded up or down to the
nearest 15 mins. These are meant to be a guideline only and discussion with the
nurse in charge and the surgeon is recommended.

TYPE OF CASE (#) AVERAGE TIME (hrs)

TKR (18) 2.25
ORIF ankle (7) 1.5
K wiring elbow (1) 2
K wiring metacarpal (1) 1.25
ORIF humerus (1) 1.75
Bancart repair (1) 2.25
Tendon repair (2) 2.75
Knee arthroscopy (4) 1.5
Shoulder arthroscopy (2) 1.5
ACL reconstruction (4) 3

Blounts repair (2) 1.25

TBW patella (3) 1.5
Ankle fusion (1) 2
ORIF tibial plateau (2) 2
ORIF radius/ ulna (7) 2
Clavicle (1) 1
Ilizarov tibia (1) 5.5
Ulnar nerve transposition 1.75

ORIF femur (2) 2.25

IM nail femur (4) 2
Austin moore (2) 1.75
ORIF distal femur (1) 2.25
Hemiarthroplasty (2) 2
Lis- Franc (1) 2.25
DHS (6) 1.75
External fixation forearm (1) 4
Ankle fusion (1) 2
ORTHOPEDIC (THEATRE 5) AUDIT

DATE:…………………………………………..

PROCEDURE START TIME END TIME

CANCELLATIONS ON DAY OF SURGERY REASON(S) e.g. theatre time, medical etc.

If theatre overruns, please outline reasons below:

e.g. underestimate of surgical time, underestimate of anaesthetic time, unforeseen
complication during surgery etc.

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