The Auditor General has released a report on operating theatres in Wales, and concluded that there is ‘considerable scope to improve theatre utilisation, reduce late starts and minimise cancellations’.
The report looks at operating theatres across Wales and examines whether operating theatre time is used efficiently and whether key safety steps are being used properly. It identifies an increased focus on patient safety through the use of tools such as the World Health Organization’s Surgical Safety Checklist although the report notes that is not always used in the best way.
The report highlights problems with:
- Expensive theatre time being lost through operating sessions not being fully utilised.
- Operations being cancelled because beds are not available for admitting patients or because patients postpone or do not turn up on the day of their surgery. Nearly half of all postponed procedures were because the patient had cancelled or did not attend their appointment.
- Health boards not effectively using data to monitor and improve theatre performance.
The Auditor General’s work has shown that theatre time is being lost through operating sessions starting late, finishing early and through gaps between one patient leaving theatre and the next patient arriving. The report highlights a range of factors that can affect theatre efficiency including poor planning of operating lists with unrealistically high or low numbers of patients being booked in for surgery, problems with theatre equipment leading to breakdowns and delays, and difficulties in meeting the recommended level of staffing.
The report also suggests that problems related to the availability of beds are a barrier to the smooth running of operating theatres and a common cause of cancellations. Theatre staff expressed frustration at not being able to run their sessions efficiently because of difficulties finding beds for their patients.
Auditor General, Huw VaughanThomas said: “Patient safety is of paramount importance to the NHS and it is good to see that the focus on safety in theatres is growing. However, operating theatres are expensive to run and there is a lot more that health boards can do to ensure that their theatre capacity is used efficiently and effectively. Achieving this will have benefits for both patients and health boards with fewer cancelled operations, and better performance against waiting time targets.”
The report makes a number of recommendations that include:
- Introducing regular audits and spot checks of surgical safety.
- Introducing a national forum for theatre improvement.
- Improving leadership of theatre services in health boards.
- Benchmarking staffing levels and skills in theatres.
- Improving the reporting of theatre performance to NHS boards and committees.
- Making data visible in theatres to contribute to a culture of improvement.
Responding to the report, Mr Timothy Havard, Royal College of Surgeons director for professional affairs (Wales) and consultant general surgeon, said: “This report warns the most common reason operations are cancelled in Wales is that there are no ward beds available. This backs-up what surgeons have been telling us about a lack of beds available in Welsh hospitals over the busy winter period. Added to that is the particularly worrying finding that in some health boards there are daily difficulties in ensuring sufficient cover for theatres because staff are being moved to work in different areas. All of this contributes to unacceptably high waiting times and causes needless distress to patients.”
He called for action to ensure that increasing bed numbers and tackling waiting lists are made a priority.
