Measuring and enhancing elective service performance in NHS operating theatres: an overview

Between April 2005 and April 2006 approximately seven million operations were performed on patients admitted to hospitals in England and Wales.1 Just over half of these procedures were carried out as day cases and nearly one million were classified as emergency cases. Operating theatres are core business in healthcare; they are a source of significant financial overheads, despite their potential for generating essential revenue. In the 2005/06 financial period the average annual cost of running a single operating theatre in Scottish NHS Trusts for 27 hours per week was £1.1 million.2 Optimizing the utilization of such an expensive resource is clearly economically desirable. In addition to potential financial benefits, the political pressures on NHS waiting lists serve to amplify the importance of effecting efficient theatre usage. If current government plans for a progressive reduction in waiting times are set to continue, national theatre output will need to be enhanced. Methods that aim to expand surgical output include: a greater shift towards ambulatory operating3,4 the development of new NHS and independent sector Treatment Centres5,6 and an enhancement of main theatre productivity in acute Trusts.7 Today's government has targeted all of the above areas through a number of national initiatives. The appropriateness of current measures of theatre performance is unsubstantiated. The first part of this article explores commonly used existing measures of theatre performance; reflects on their limitations and possible alternatives. The remainder of the article discusses strategies by which theatre productivity and hence performance can be improved.