Efficiency Status of the Elective Non-Cardiac Surgery Operating Rooms of the Department of Surgery of the Philippine General Hospital

Marie Carmela M. Lapitan,1,2,3 Brian S. Buckley,1 Donna D. Abalajon,1
Patricia Lorna O. Cruz4 and Maria Eliza M. Raymundo1,3,5

1Department of Surgery, College of Medicine and
Philippine General Hospital, University of the Philippines Manila
2Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila
3Department of Surgery, Uniformed Services University of the Health Sciences, Maryland, USA
4Department of Anesthesia, College of Medicine and
Philippine General Hospital, University of the Philippines Manila
5Institute of Molecular Biology and Biotechnology, National Institutes of Health,
University of the Philippines Manila

Introduction. The operating room (OR) is one of the most cost-intensive units of any health care facility. Hence, OR effeciency has become a priority of many institutions. Delays in the OR lead to poor cost effectiveness and cause frustration both to patients and to OR staff.

Objectives. This study aims to describe the efficiency of the Philippine General Hospital Department of Surgery elective non-cardiac surgery operating room services using established parameters and identify causes of delays.

Methods. A cross-sectional survey was conducted of randomly selected elective cases from October 2011 to January 2012. A framework of elements in the OR process and timing milestones were defined. These times were recorded during the OR process. Mean and median observed times for these elements were calculated and compared with target times based on previous research. Causes of delay were recorded.

Results. Once anesthesia was started, target times for most parameters were met in the majority of cases. Delays were most notable between patient entry to the OR complex and start of anesthesia, particularly for first cases. Only 3.9% of cases started at or before the scheduled time; 49.7% of cases started more than one hour late. 54.3% of late starts were caused by surgeons not being in the OR complex on time. Errors in estimating case duration were commonplace: more than one third of cases took more than an hour longer or shorter than estimated. While the mean delay in start for first cases was nearly one hour, the mean delay for second and third cases was nearly two hours.

Conclusion. The majority of cases start late. The most common cause of delay is the surgeon's tardiness. Considerable discrepancy between the predicted and actual case duration was also observed.

Key Words: operating room efficiency, OR delays, efficiency parameters, case duration error, surgery, Philippines