Operating Lists (operating + list)

Distribution by Scientific Domains

Selected Abstracts

Two-week target for laparoscopic cholecystectomy following gallstone pancreatitis is achievable and cost neutral,

S. J. W. Monkhouse
Background: The British Society of Gastroenterology recommends that all patients with gallstone pancreatitis should undergo cholecystectomy within 2 weeks. This study assessed whether these guidelines are feasible and cost-effective. Methods: Admissions for gallstone pancreatitis between January 2006 and January 2008 were reviewed. Readmissions for subsequent pancreatitis or biliary pathology were noted together with additional investigations, severity scores, hospital stay and time to cholecystectomy. The costs of readmission and theoretical costs of developing a dedicated operating list were provided by independent accountants. Results: During the 2 years, 153 patients were admitted. Twenty-one patients (137 per cent) had further attacks requiring 40 readmissions. There were no deaths. Additional hospital costs related to readmissions were 172 170, including bed occupancy (67 860), investigations (12 510) and 153 cholecystectomies on an existing theatre list (91 800). The estimated cost of staffing a half-day theatre list every fortnight, performing 153 cholecystectomies, was 170 391. Conclusion: Instigating a dedicated theatre for cholecystectomy after biliary pancreatitis has many potential benefits. The costs of readmissions and ad hoc operating are balanced by those of a dedicated theatre list in the long term. Implementation of the guidelines would save approximately 900 annually and be cost neutral. Copyright 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Measuring the quantitative performance of surgical operating lists: theoretical modelling of ,productive potential' and ,efficiency'

ANAESTHESIA, Issue 5 2009
J. J. Pandit
Summary We previously defined surgical list ,efficiency' as: maximising theatre utilisation, minimising over-running, and minimising cancellations. ,Efficiency' maximises output for input; ,productivity' emphasises total output. We define six criteria that any measure of productivity (better termed ,quantitative performance') needs to satisfy. We then present a theoretical analysis that fulfils these by incorporating: ,speed' of surgery (with reference to average speeds), ,patient contact' (synonymous with minimising gaps between cases), and ,efficiency' (as previously defined). ,Speed' and ,patient contact' together constitute a ,productive potential'. Our formula satisfies the pre-set criteria and yields plausible results in both hypothetical and real data sets, To be productive in these quantitative terms, teams in any specialty need to achieve minimum quality standards defined by their sub-specialty; to plan their lists to utilise the time available with no cancellations or over-runs and to work at least as fast as average with minimal gaps between cases. ,Productive potential' combined with ,efficiency' yielding ,actual productivity' in our theoretical analysis more completely describes quantitative surgical list performance than any other single measure. [source]

Estimating the duration of common elective operations: implications for operating list management

ANAESTHESIA, Issue 8 2006
J. J. Pandit
Summary Over-running operating lists are known to be a common cause of cancellation of operations on the day of surgery. We investigated whether lists were overbooked because surgeons were optimistic in their estimates of the time that operations would take to complete. We used a questionnaire to assess the estimates of total operation time of 22 surgeons, 35 anaesthetists and 16 senior nursing staff for 31 common, general surgical and urological procedures. The response rate was 66%. We found no difference between the estimates of these three groups of staff, or between these estimates and times obtained from theatre computer records (p = 0.722). We then applied the average of the surgeons' estimates prospectively to 50 consecutive published surgical lists. Surgical estimates were very accurate in predicting the actual duration of the list (r2 = 0.61; p < 0.001), but were poor at booking the list to within its scheduled duration: 50% of lists were predictably overbooked, 50% over-ran their scheduled time, and 34% of lists suffered a cancellation. We suggest that using the estimates of operating times to plan lists would reduce the incidence of predictable over-runs and cancellations. [source]

The role of the adult urologist in the care of children: findings of a UK survey

D.F.M. Thomas
Objective To document the current role of adult urologists in the care of children in the UK and to consider the future provision of urological services for children within the context of published national guidelines. Methods A detailed postal questionnaire was sent to all 416 consultant urologists listed as full members of the British Association of Urological Surgeons and resident in the UK. The range of information sought from each urologist included details of personal paediatric training, scope of personal practice, and information about facilities and provision of urological services for children in their base National Health Service hospital. Results The response rate was 69%; most consultant urologists (87%) in District General Hospitals (DGHs) undertake paediatric urology, mainly routine procedures of minor or intermediate complexity. Of urologists in teaching hospitals, 32% treat children but their involvement is largely collaborative. Consultants appointed within the last 10 years are less willing to undertake procedures such as ureteric reimplantation or pyeloplasty than those in post for ,10 years. Currently, 18% of DGH urologists hold dedicated children's outpatient clinics and 34% have dedicated paediatric day-case operating lists. Almost all urologists practise in National Health Service hospitals which meet existing national guidelines on the provision of inpatient surgical care for children. Conclusion Urologists practising in DGHs will retain an important role as providers of routine urological services for children. However, the tendency for recently appointed consultants to limit their practice to the more routine aspects of children's urology is likely to increase. Training and intercollegiate assessment should focus on the practical management of the conditions most commonly encountered in DGH practice. The implementation of national guidelines may require greater paediatric subspecialization at DGH level to ensure that urologists treating children have a paediatric workload of sufficient volume to maintain a high degree of surgical competence. [source]