Theatres are a key resource of all major hospitals, but also account for large resource costs. In most hospitals the drive for cost containment and increased patient volume in operating theatres is very evident. Here costs are measured in minutes and revenue gained on a per case basis. Almost without exception, in every hospital there is an ongoing problem of operating theatres finishing before the planned finish times, as well as operations being cancelled, or indeed over running time with the inevitable knock-on effects.
Now there is a robust and evidence-based solution to stopping operating theatres losing money, work more effectively and increase utilisation. For the first time, operating theatres can consistently run at up to 95% utilisation across virtually all specialties with the resulting benefits to all staff, patients and of course, the Trust’s finances.
While this can be perceived as highly challenging due to the inherent variable and unpredictable nature of surgery, several NHS Trusts in the UK that have been working with Alturos’ Theatre Optimisation Method (ATOM) clearly demonstrate how this is being achieved consistently and across a wide range of surgical specialties.
We recently spoke to Sheffield Teaching Hospitals NHS Foundation Trust, Hinchingbrooke Hospital and Luton and Dunstable Hospital to hear what and how they are achieving with ATOM.
Overview of the work at Sheffield Teaching Hospitals NHS Foundation Trust
What appealed to Sheffield Teaching Hospitals NHS Trust was the fact that the data could be analysed before any work with ATOM started. This helped clearly outline the opportunity for improvement that existed in each specialty. Urology was the first specialty to try the method.
Following a meeting with the surgeons where the approach to calculating more predictable procedure time for each surgeon was presented, the majority of surgeons volunteered to take part in the first phase. New scheduling times were produced, piloted, monitored and reviewed with surgeons, theatre staff and the schedulers.
The benefits derived following the ATOM trial in Urology include:
Jacky Rawlins, Group General Manager, Sheffield Teaching Hospitals NHS Foundation Trust said: “Alturos predicted an increase in around 10% of session utilisation, although some members of the team were sceptical – this is what we got, and now the whole organisation is wanting to use the method in their clinical service.
“For the pilot project in Urology it took just six weeks from starting to achieve this increase and has been stable or increasing ever since. We are now nearing completion of rolling ATOM out across all specialties with similar results. In addition, we have improved our planning for on-day admission reducing delays and ultimately finishing as predicted; staff morale has improved across the multidisciplinary team.”
Sheffield Teaching Hospitals NHS Foundation Trust initial increase in utilisation and associated financial value across six diverse specialties.
Jim Hearn of Alturos said: “The other key element for Sheffield was to have a model that was effective in terms of translating theatre efficiency into real benefits. The methodology has allowed them to add support into the team to increase surgical time and ensure each list is profitable against the service line thus reducing the number of lists per annum required against contracted activity.”
The success of ATOM in Urology led to it being rolled-out in to all other specialties. The benefits derived at the time and that continue to improve, include:
- £1,200,000 benefit through applying to all specialties
- Reduction in operating costs of £710,000, however, if the demand existed and was commissioned, this could be turned in to approximately £3,000,000 of additional income
- Patient activity along pathways is now more predictable, as theatres have better control
- According to benchmarking data, surgical time (knife to skin) in most Trusts is 60%. In Urology, this ran at 70–80% after ATOM
Hinchingbrooke Health Care NHS Trust: ophthalmology scheduling
Hinchingbrooke is a contrasting case study as it has a relatively small ophthalmology service: 10 sessions per week of activity. However over a seven-week implementation period it realised a 13% improvement in the throughput of patients in ophthalmology. Scheduling was re-devised in ophthalmology and orthopaedics and process constraints identified.
As a result the ophthalmic consultant said, “There has been a real change in the practice around booking theatre lists. This change in practice has led to 70% of lists finishing on time, with a reduction in the finish time variation and an increase in the total time operating.”
Luton & Dunstable Hospital
A re-design of the consultant’s timetable was conducted over the spring and summer of 2014. The drivers for this redesign included:
Remove three session days (were 3 * 3.5 hour sessions per day)
- The sessions got progressively less efficient/utilised as the day progresses
- Staffing three sessions caused double sessions to work like two singles (with staff changes)
- People didn’t like them
Fitting the demand into 2 * 4.5 hour sessions per day
- A preference to have all day sessions (10 hours with flexible lunch)
- Reducing start time delays
- Reducing over running
- Ensuring an effective schedule of patients
Stabilise and standardise the theatre usage
- Fixed trauma and emergency theatres
- Dedicated theatres where possible per specialty
Avoid loading constraints
- Reducing days where three image intensifiers will be needed
- Reducing the maximum bed loading across the week (level bed load)
Improving the session utilisation
- Generating templates with flexibility to allow for cross cover of theatre sessions
- Ensuring each specialty has the right amount of timetabled capacity
It was evidenced that the new timetable has generated a similar level of activity as before, with a lower cost to run it. The data analysis included extra lists, whereas the new timetable incorporates previous extra activity in planned hours.
There is some spare capacity to allow for future growth while start times and the percentage of list spent starting has improved in all specialties. The over running specialties have reduced and the finish time is better across all specialties. Utilisation has increased significantly.
The results after the trials were as follows:
Cathy Jones, General Manager, Surgical Division, Luton & Dunstable University Hospital NHS Foundation Trust said: “At the beginning of our roll-out of ATOM, we noticed that the teams were talking and thinking differently about scheduling, and excited to realise the benefits from using the new model. The preparation phase of the scheduling times was relatively painless and our consultant teams have risen to the challenge of interrogating and understanding their procedure lists. The booking team has responded really well to a consistent and robust set of timings, and we have taken the guesswork out of scheduling.”
Ricky Shah, of Luton and Dunstable hospital’s finance department confirmed that the new timetable was costing £650,000 less to run in terms of planned staff time than before ATOM.
ATOM involves and engages with surgeons and uses appropriate language and methods. It also is easily understood and applied by schedulers. It makes theatre scheduling more predictable and sustainable.
With clinically sound science at its heart, together with a range of transformation methods and staff engagement frameworks, Jim Hearn, Dr Tim Franklin and the team at Alturos spent over two years developing ATOM (Alturos Theatre Optimisation Model). This has successfully transformed theatre utilisation and capacity in every hospital and specialty where it has been implemented.