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Operating Theatre Efficiency
Published by the State of Queensland (Queensland Health), January 2017
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Summary
The Queensland Government’s, ‘My health, Queensland’s future: Advancing health 2026’ strategy
describes the challenges faced by public healthcare in Queensland, “Our population is ageing. A
growing number of Queenslanders live with chronic disease. Better clinical interventions and new
technologies offer the prospect of improved health outcomes. But health costs are rising and we need to
be smarter about how we deliver healthcare into the future.”
Further to this and in support of the need to deliver sustainable, efficient and effective services, in April
2016, the Queensland Audit Office (QAO) published the Queensland public hospital operating theatre
efficiency report 2015-16. The report concluded that, “Public hospitals can substantially improve their
theatre efficiency, both by increasing utilisation and by better managing their costs of surgery. That more
can be done within existing theatre infrastructure is indicative of the potential cost savings that can be
realised in the system.”
There were ten recommendations made in the report, including the need for the development of
standardised definitions, performance measures and targets, improving operating theatre governance,
reviewing theatre schedules and staff rosters and improving costing and coding services.
The following guidelines have been developed as a best practice guide for Hospital and Health Services
(HHSs) to understand and improve theatre efficiency, governance and operational management.
2. Scope
The guideline applies to all operating theatres in public hospitals in Queensland, referred to hereafter as
Hospital and Health Services (HHSs) including Mater Public Services.
Compliance with this guideline is not mandatory, but sound reasoning must exist for departing from the
recommended principles within the guideline.
It is recognised that there are many aspects of operating theatre efficiency and management that are not
addressed in version 1.0 of this document. As future versions of this guideline are developed over time
to stay up to date with best practice, additional influences will be addressed, including;
• Workforce standards
• Quality and safety
• Operating theatre costing
• Evidence-based scheduling
• Emergency surgery
Both the guideline and the associated measures and key performance indicators (KPI’s) are
developmental documents that will be reviewed and expanded as part of a staged implementation plan.
It is important to note that where measures and KPI’s have been described, statewide targets will not be
set for the first year of implementation. The approach to establishing targets and benchmarks will follow
a progressive, evidence-based approach whereby collection for the first 12 months will focus on
assessing relative performance to enable the Department to understand the level of variation. This will
ensure appropriate targets are set in the future with the expectation that these will be applied as stepped
improvement targets from Year 2 of the implementation plan.
Guidelines
3.1 Purpose
The purpose of the Queensland Health Theatre Efficiency Guideline is to provide a best practice guide
for operationally managing efficient public hospital operating theatres by:
1. Providing a minimum suite of agreed upon definitions, performance measures and targets to
support Hospital and Health Services and hospitals to manage, benchmark and improve theatre
performance;
2. Clarifying and formally communicating roles, responsibilities and accountabilities for delivering
efficient surgical services, both operationally and strategically;
3. Outlining the governance structure (e.g. Theatre Management Committee) by which public
hospitals should monitor the efficient use of theatres; and
4. Highlighting the major cost drivers of operating theatres
The primary focus of the document is planned (elective) surgery, though it is expected that some
aspects will also be relevant for unplanned (emergency) surgery.
3.2 Understanding Theatre Efficiency
3.2.1 The Whole Patient Journey
There are numerous factors within the perioperative setting that influence the efficiency of operating
theatres. Such factors extend beyond the immediate theatre environment and include the entire
continuum from planning, scheduling, pre-assessment and through to discharge. The following diagram
represents the three primary phases of the perioperative setting that contribute to the efficient and
productive use of operating theatres and associated resources.