The focus on safety in operating theatres in Wales has improved, but health boards must ensure they are used more efficiently, says a report published today.
Expensive theatre time is being lost because operating sessions are not being used fully, says Auditor General for Wales Huw Vaughan Thomas.
Late starts – a "common occurrence" says the report – early finishes, and cancellations are among the problems.
His report concludes that there is "considerable scope to improve theatre utilisation, reduce late starts and minimise cancellations."
The performance of operating theatres across Wales was examined by the Auditor General’s office in 2011, and followed up during 2014 and 2015.
In the interim, while the new report identifies an increased focus on patient safety through use of the World Health Organization’s Surgical Safety Checklist and other methods, the main conclusion from the follow-up work is that "the focus on theatre efficiency and productivity has waned.
"Many theatres remain under-utilised and there are barriers to improvement along the entire patient pathway, not just within theatres," states the report.
It highlights 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 operations in Welsh hospitals during the follow-up study were due to patients cancelling or not turning up.
It was also found that health boards are not effectively using data to monitor and improve theatre performance.
A range of factors can affect theatre efficiency, including poor planning of operating lists with unrealistically high or low numbers of patients booked in for surgery, theatre equipment breakdowns, and difficulties achieving recommended staffing levels.
In 2011, Aneurin Bevan University Health Board’s approach to improving the use of theatres, through the Transforming Theatres Programme, was praised by NLIAH, the National Leadership and Innovation Agency for Healthcare, as leading the way in Wales.
But the report states that today, "there is no longer a national programme of theatre improvement in Wales, there has been a reduction in the extent to which national targets focus on theatres, and the Welsh Government’s Delivery Unit has stopped work on theatre improvement.
"The profile of theatres has waned within most health boards and NHS boards tend to receive little regular information on theatre performance."
Among the report’s nine recommendations are: Introducing regular audits and spot checks of surgical safety; improving leadership of theatre services in health boards; benchmarking staffing levels and skills in theatres; and improving the reporting of theatre performance to NHS boards and committees.
Source: Free Press Series