Optimising the use of operating theatres is critical if the number of operations carried out at Mater Dei Hospital is to be increased and waiting times for elective surgery shortened, according to a National Audit Office report presented in Parliament yesterday.
Some 20 per cent of the patients have been waiting for their intervention for at least a year
The 112-page report concluded that, despite the “significant” increase in the number of operations carried out, it transpired that there was still scope to further increase theatre utilisation.
Among its recommendations, the NAO lists options to expedite the recruitment of key staff, particularly those considered as essential for the hospital’s operations, including “increasing MDH’s autonomy over the recruitment function”.
Elective surgery is considered by Mater Dei to be “an intervention that may be scheduled or delayed by at least 24 hours”. About 20 per cent of the patients have been waiting for their intervention for at least a year.
It found that there is lack of clearly defined theatre hours that are contractually allocated to each consultant.
The NAO says that, despite its critical importance and the fact that they rank among the hospital’s most valuable assets, “to date, the hospital does not have appropriate IT-based programmes to facilitate the management of its operating theatres”.
In July last year, the main theatres were used for a total of 2,455 hours – an average of 31 hours a week for each theatre.
Five endoscopy operating rooms were used for about 449 hours or an average of 27 hours a week per theatre.
In July, theatre plans show there were 424 morning and 81 afternoon sessions in the theatres.
The audit revealed that in 145 of these 505 cases, there were delays of more than 30 minutes in session start-up – relating mainly to clinical issues.
During the same period, in 115 of 424 instances, theatre sessions over-run occurred, amounting to 190 hours. In 43 per cent of these, the over-run amounted to less than one hour in each session.
Among its recommendations to address the situation, the NAO says efforts to increase the number of day-surgery cases are to be to optimise bed turnover and the operating theatre’s infrastructure.
It calls for the evaluation of options to address the historical re-occurrence of beds being occupied by patients requiring long-term care and recommends that, in the short term, efforts are made to transfer these patients to other institutions or residences, such as through public-private partnership (PPP) initiatives.
The Audit Office says that the process to implement fully the centralised waiting list system is to be expedited. Moreover, consideration is to be given to ensure that this system has in-built data validation and integrity mechanisms. Departments already making use of the system should complete all the information required.
The report recommends the computerisation of data related to operating theatre activities.
The Audit Office is advocating that the hospital management develop and communicate with the multidisciplinary teams its policies relating to operating theatre processes – “operation morning and afternoon session start-times, turnaround times between operations and procedures to be followed for changes to existence sessions and requests for extra sessions”.
The report urges the hospital management to ascertain that job plans for senior resident specialists and consultants clearly define how clinical hours are to be allocated between outpatients, ward rounds, operating theatres and other functions.
Jobs plans are to include key performance indicators.
It also calls for the strengthening of the audit trail relating to the completion of the daily intervention lists of patients to undergo elective surgery.
The NAO report concludes that “the assignment of all management positions is considered as a prerequisite to ensure the appropriate level of management control”. In this regard, it considers as a matter of urgency the appointment of the head relating to management responsibilities of operating theatres, which is vacant.