A STUDY ON OPERATION THEATRE UTILIZATION IN A REPUTED HOSPITAL IN SOUTH MUMBAI

1. OT1 UTILIZATION REVIEW
AT
XYZ HOSPTAL
BY DR.SUGATA PYNE
BHMS, MHA
TISS,MUMBAI
2012-14

2. OBJECTIVES
• To find out the capacity utilization and actual
utilization time of OT1 .
• To find out the reasons for the gap in available
working time and utilization time of the OT (if
any).
• To find out the type of surgeries that take place in
the OT and analyze the related information.
• To suggest measures to improve the utilization of
the OT.

3. METHODOLOGY
• A retrospective study was done of OT1.
• An observational study of the workflow of the
OT was done from 01.09.2013 to 21.09.2013
using non-participation approach.
• Data Analysis: Data was analysed with the help
of MS-Excel.

4. Working of OT
• The OT works from 8 am to 4 pm Monday to
Saturday.
• 8 hours daily
• 10 minutes between surgeries for cleaning
and restoration
• Sunday : repair and maintainence.

5. Patient admitted on previous evening of
scheduled surgery date and prepared for
surgery next morning.
Anaesthesist and surgeon arrives.
Patient called from ward 15 minutes
before scheduled surgery time. Ward boys
of respective ward takes the patient to OT
Immediately after surgery patient taken
out of OT and kept in recovery room till
patient gains consciousness
After gaining consciousness, patient sent
to ward

6. 35
30
25
20
15
days of month
10
working days
5
0
JA FE MA AP MA JU
AU
OC NO DE
JUL
SEP
N B R R Y N
G
T V C
days of month 31 29 31 30 31 30 31 31 30 31 30 31
working days 25 25 25 24 26 26 26 25 25 27 25 25

7. NO. OF HOURS OF OT UTILIZATION
160
140
120
100
80
Series 1
60
40
20
0
JAN FEB
Series 1 86
MA
NO
APR MAY JUN JUL AUG SEP OCT
DEC
R
V
96 112 115 122 135 145 98
83 103 76
98

8. 250
HOURS
UTILIZED
200
150
100
50
0
JAN FEB
MA AP MA
AU
OC NO
JUN JUL
SEP
DEC
R R Y
G
T V
HOURS UTILIZED 86 96 112 115 122 135 145 98 83 103 76 98
AVAILABLE HOURS 196 196 196 188 204 204 204 196 196 212 196 196

9. 80
PERCENTAGE UTILIZATION
70
60
PERCENTAGE
UTILIZATION
50
40
30
20
10
0
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
PERCENTAGE
43.9 49.0 57.2 61.1 59.9 66.3 71.2 50.0 42.3 48.6 38.8 50.0
UTILIZATION

10. UTILIZATION OF OT1 IN 2012
• Total hours available = 2380.9 hours
• Total hours utilized = 1269
• Percentage utilization
hours
= 53.29%

11. TOTAL = 443
AVG = 37/ month
TOTAL SURGERIES
60
50
40
30
20
10
0
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Series 1 38
37
37
33
51
40
34
35
30
40
29
39

12. SURGERY NUMBERS BY SPECIALITIES
NUMBER
350
300
Axis Title
250
200
150
100
50
0
NUMBER
CARDIA
C
ORTHO
ENT
EYE
55
320
20
12
UROLO REPROD
OTHERS
GY
UCTIVE
8
3
25

13. PERCENTAGE BREAKUP OF SURGERIES
3%
0%
2%
6%
12%
4%
CARDIAC
ORTHO
ENT
EYE
UROLOGY
OTHERS
REPRODUCTIVE
73%

14. BREAK UP OF ORTHO SURGERIES
SINGLE TKR
BIL. TKR
31%
34%
ACL RECONSTRUCTION
ARTHOSCOPY
8%
8%
19%
OTHERS (THR, ORIF, KWIRE, SHOULDER
REPAIR, PLATING

15. BREAKUP OF CARDIAC SURGERIES
2%
2%
CABG
4% 4%
AVR
5%
ASD CLOSURE
5%
PACEMAKER BATTERY
REPLACEMENT
HICKMAN CATHETER
INSERTION
78%
THORACOSCOPY
MVR

16. TOTAL = 43
AVG = 3.5
CABG
AVG TIME = 3-12 hrs.
8
7
6
5
4
3
2
1
0
JAN
FEB
MAR
APR
MAY
JUN
6
1
4
7
1
4
JUL
5
AUG
3
SEP
1
OCT
4
NOV
3
DEC
4

17. AVG TIME:
LT TKR= 2.56 hrs
RT TKR = 2.66 hrs
25
SINGLE SIDED TKR
TOTAL = 110
AVG = 9
20
15
10
5
0
JAN
2
FEB MAR APR MAY JUN
20
11
6
10
8
JUL AUG SEP OCT NOV DEC
11
10
5
11
9
7

18. AVG TIME = 4.6 hrs
BILATERAL TKR
9
8
TOTAL = 62
AVG = 5
7
6
5
4
3
2
1
0
JAN
6
FEB MAR APR MAY JUN
1
8
6
5
7
JUL AUG SEP OCT NOV DEC
7
3
5
4
4
6

19. AVG TIME = 2.24 hrs
TOTAL = 18
AVG = 1.5
COCHLEAR IMPLANT
7
6
5
4
3
2
1
0
JAN
FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC
3
2
0
0
0
6
2
1
0
1
3
0

20. TOTAL = 25
AVG = 2
ACL RECONSTRUCTION
AVG TIME = 1.26 hrs
7
6
5
4
3
2
1
0
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
5
0
0
0
4
0
0
6
0
2
2
6

21. TOTAL = 24
AVG = 2
KNEE ARTHOSCOPY
AVG TIME = 1.3 hrs
6
5
4
3
2
1
0
JAN
0
FEB MAR APR MAY JUN
4
3
1
2
0
JUL AUG SEP OCT NOV DEC
0
1
5
0
4
4

22. 30
TOTAL = 186
AVG = 15.5/month
25
20
15
LATER TO 8 AM
10
WORKING DAYS
5
0
JA FE M AP MA JU
AU SE OC NO DE
JUL
N B AR R Y N
G P T V C
LATER TO 8 AM 16 17 15 16 18 13 19 15 9 21 15 12
WORKING DAYS 25 25 25 24 26 26 26 25 25 27 25 25

23. PERCENTAGE OF CASES STARTING AFTER 8 AM
PERCENTAGE
90
80
70
60
50
40
PERCENTAGE
30
20
10
0
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

24. @ 8 AM= 48 CASES
AFTER 8
A.M START
8.15 AM TO
8.30 AM
83 CASES
8.45 AM TO
9.45 AM
48 CASES
10 AM TO
12 AM
42 CASES
AFTER
12.30 PM
17 CASES

25. 24 CASES
STARTED
BEFORE 8 A.M
6 AM
1 CASE
7 A.M
4 CASES
7.15 AM TO 7.45
AM
19 CASES

26. TOTAL = 83
AVG = 7/month
SURGERIES AFTER 4
60
50
40
30
20
10
0
JAN FEB
NO. OF SURGERIES 38
AFTER 4
3
37
7
MA
APR MAY JUN JUL AUG SEP OCT NOV DEC
R
37
8
33
7
51
8
40
9
34
11
35
6
30
6
40
6
29
3
39
9

27. DEC
NOV
OCT
SEP
AUG
JUL
JUN
MAY
APR
MAR
FEB
JAN
PERCENTAGE
35
30
25
20
15
PERCENTAGE
10
5
0

28. NUMBER OF SURGERIES AFTER 4 PM
NUMBER OF SURGERIES
35
30
25
20
15
10
5
0
NUMBER OF SURGERIES
UPTO
4.30
PM
UPTO
5 PM
UPTO
5.30
PM
UPTO
6 PM
AFTER
6 PM
10
15
16
12
30

29. • Out of 304 starts, 48 starts (15.8%) were at 8
am. Rest were either delayed or before 8 am
as shown previously

30. TOTAL = 43 DAYS
AVG = 3.6
DAYS/MONTH 8
NO SURGERY DAYS
NO SURGERY DAYS
7
6
5
4
3
2
1
0
JAN FEB MARAPR MAY JUN JUL AUG SEP OCT NOV DEC
NO SURGERY DAYS 4
3
3
2
1
5
4
3
6
2
7
3

31. FINDINGS OF 2012
• Underutilization of OT1.
• The hospital whose forte is cardiac surgery
does more ortho surgeries.
• A good percentage of surgeries occur beyond
the schedule hours [8 AM TO 4 PM].
• Around 1 and ½ months out of 12 months has
been wasted.
• Delay of start of OT due to late arrival of both
doctors and patients

32. Utilization from Jan 2013-June 2013
• Total available hours = 1183 hours
• Total utilized hours = 556 hours
• Percentage utilization = 47%

33. The not-so-bright current
picture
The following observations were made during
the OT study between Sept 1 to Sept 21.
 Available hours = 133.2 hours
 Utilized hours = 56.3 hours
 Utilization = 42.26%
 Cancelled surgeries = 3

34.  Total surgeries conducted = 19.
 Number of surgeries conducted per day is 0.90
as compared to 1.23 in 2012.
 14 (73.6%) ortho surgeries as compared to
73% in 2012.
 3 (15.7%) cardiac surgeries as compared to
12% in 2012.
 2 (10.5%) ENT surgeries as compared to 4% in
2012.

35. DELAY IN
SURGERIES
SCHEDULED
DELAY
4 CASES
NON
SCHEDULED
DELAY
10 CASES

36. DATE
SURGERY NO.
DELAY IN START
REASON
3.09.2013
1. TKR
90 MIN
LATE ARRIVAL OF
PATIENT
2. TKR
30 MIN
LATE ARRIVAL OF
PATIENT
4.09.2013
1. TKR
45 MIN
LATE ARRIVAL OF
PATIENT
6.09.2013
1. COCHLEAR
IMPLANT
30 MIN
LATE ARRIVAL OF
PATIENT
30 MIN
LATE ARRIVAL OF
PATIENT
60 MIN
LATE ARRIVAL OF
SURGEON
2. CANCELLED
10.09.2013
1. COCHLEAR
IMPLANT
2. CANCELLED
14.09.2013
1. BHP
2. CANCELLED
16.09.2013
1.THR
30 MIN
LATE ARRIVAL OF
PATIENT
17.09.2013
1.TKR
45 MIN
LATE ARRIVAL OF
PATIENT
18.09.2013
1. ASD CLOSURE
30 MIN
LATE ARRIVAL OF
SURGEON
20.09.2013
1. TKR
30 MIN
LATE ARRIVAL OF
SURGEON

37.  Patient delays : 7 out of 19 surgeries ( 2 ENT, 3
TKR surgeries) due to improper arrival of
patients. Average delay = 43 minutes. Highest
delay = 90 minutes. Lowest delay = 15 minutes
 Doctor delays :3 out of 19 surgeries were
delayed due to late arrival of doctors. Average
delay time = 40 minutes.
 Bilateral TKR scheduled for 3 hours but goes
on for 5 hours. Average bilateral TKR surgery
time = 4.6 hours.

38. RECOMMENDATIONS
• Reduce the incidence of surgeries before 8 a.m and
after 4 p.m to reduce the load on the nurses and
avoiding overtime payments:
The hospital OT already suffers from the problem of
shortage of nursing staff. To add to the problem the
nurses available are distributed before and beyond the
schedule hours to tackle the surgeries occuring at nonschedule hours. Instead if all surgeries are scheduled
within the schedule hours, all the available nursing
staff can be utilized at the same time. Also overtime
remuneration can be avoided.

39. • To reverse the trend of less cardiac surgeries in a
cardiac centric hospital.
• Reduce the number of no surgery days or give offs to
nurses and ward boys on those days.
• Follow up in the following years to keep track of OT
utilization and other related data.
• It has been found that mostly ENT surgery patients
come to the hospital in the same day of surgery
sometimes exactly at the time when the surgery is
scheduled or much later to the scheduled time. There
is some time required by the nurses to prepare
him/her for the surgery and to complete the necessary
paper works. This results in loss of precious OT time.
Adequate steps must be taken to prevent this.
• Design a marketing program to attract more doctors
and patients.