Performance audit: managing operating theatre efficiency for elective surgery

Public health Elections Performing arts Australia New South Wales

This report finds that NSW public hospitals are treating patients within national clinical timeframes, however increased operations will be required as targets increase and demand grows.


“Thousands more people could be operated on in the NSW public health system if operating theatres ran more efficiently,” said Mr Achterstraat. “Waiting times for elective surgery will continue to increase if NSW Health does not improve its management of operating theatres,” he added.

On the positive side NSW public hospitals are performing more elective surgery than in previous years and are treating patients substantially within national clinical timeframes. However, more operations will be needed as targets are getting tighter and demand is growing.

 There is capacity to do more elective surgery using existing resources. If NSW Health met its own theatre utilisation targets for elective surgery an estimated 20,000 more operations could be achieved each year.

 “Hospitals just need to start the first operations of the day on time, stay on time and reduce the numbers of cancellations,” said Mr Achterstraat.

 “Less than half the scheduled first operations started on time over the past three years,” said Mr Achterstraat. “In some hospitals less than 10 per cent of first operations start on time, yet in other hospitals over 95 per cent start on time,” he added.

 The problem is that it is not always clear who is in charge. Operating theatre managers have limited authority or influence over day-to-day theatre efficiency.

 “Someone clearly needs to be in charge of the operating theatre; with the same authority and skill as the matrons of the past,” said Mr Achterstraat. “They should be backed up by strong, active operating theatre committees bringing together surgeons, anaesthetists, nurses and hospital executives,” he added.

 “I am pleased that NSW Health is developing best practice guidelines for operating theatre management and governance,” said Mr Achterstraat.

 To really manage operating theatres well, hospitals need far better information on costs and productivity. A greater understanding is required of the number of theatre hours and operations funded and the degree of spare capacity.

 Hospitals should also question why over a quarter of theatre cases are non-surgical, such as endoscopies and colonoscopies which could be done in procedure rooms rather than using up valuable operating theatre time.

 The cost of elective surgery varies considerably between hospitals. For example, NSW Health needs to better understand why the average cost of knee replacements in some local health districts is $13,177 and in others is $22,638.

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