The prime source of revenue comes from the operation theatre (OT) of a hospital. Nevertheless, the area of OT corresponds to sizeable expenditure for a hospital unit budget which demands maximum utilization of operation theatre to make certain optimal cost-benefit.
OT Utilization can be defined as the measure of hours of theatre time that is actually utilized during elective resource hours and also considers the total number of optional resource hours available for use for optimal utilization of theatre time (Augusto et al., 2010).
An Operation Theatre (OT) is a vital facility of any healthcare unit. This specialized service of the hospital is directed towards lifesaving procedures carried out in strict aseptic conditions under controlled environment. A room in a hospital equipped for the performance of surgical operations is called Operation Theater.
The objective of this study was to assess the overall utilization of operation theaters in terms of hours. To assess the extent to which different departments are utilizing the allocated hours and to identify the proportion of (unplanned or planned) of surgeries and to suggest measures to improve the utilization of the OT of Satguru Pratap Singh Hospital, Ludhiana for the time period of February 2017 to May 2017.
The existing study concentrates to understand the pattern and course of Utilization of operation theatre of Satguru Pratap Singh (SPS) Hospital in Ludhiana district of Punjab. This report also suggests the hospital for improving the utilization of operation theatre further.
Of the 663 surgeries cases done, 483(72.9%) were planned and 180(27.1) % were unplanned or were emergency surgeries. Among the departments, General Surgery had the maximum number of surgeries (140) and Pediatric department had the least number of surgeries (22).
ACKNOWLEDGEMENT
I owe a great debt to all professionals at SPS HOSPITALS, LUDHIANA for generously sharing their knowledge and time, which inspired me to do my best at this project study.
My heartfelt gratitude to Dr. Shally Deora (Deputy Medical Superintendent), Dr. Gurpreet Kaur (Senior Executive- Operations) and Sis. Jaspreet (In charge – OT) for showing their keen interest in the study and for sharing their views in spite of their very busy schedule. It has been my privilege to work under their dynamic supervision at the Hospital.
My sincere gratitude to my guide Dr. S.D. Gupta (Chairman, IIHMR, Jaipur) for his valuable suggestions and guidance. My regards go to Dr. Ashok Kaushik (Dean-Academics & Students Affairs, IIHMR, Jaipur) for his very helpful attitude and relentless support.
Dr. Prateek Lehri
MBA- HM 20 (2015-2017)
IIHMR, Jaipur
Table of Contents
ABSTRACT 3
CHAPTER ONE 7
Introduction 7
CHAPTER TWO 7
Review of literature 9
CHAPTER THREE 10
Research timeframe 10
Research limitation 11
CHAPTER FOUR 11
Analysis and findings 11
CHAPTER FIVE 40
References 42
ABBREVIATIONS
ENT Ear Nose Throat
GI Gastrointestinal
GYNAE Gynecology
JCI Joint Commission International
NEURO Neurology
OT Operation Theatre
OPTHAL Ophthalmology
ORTHO Orthopedic
PAED Pediatrics
SPS Satguru Pratap Singh
URO Urology
CHAPTER ONE
INTRODUCTION
An Operation Theatre (OT) is a vital facility of any healthcare unit. This specialized service of the hospital is directed towards lifesaving procedures carried out under strict aseptic conditions under a controlled environment. The lifesaving or improving procedures are carried out by trained personnel to ensure the cure and healing with maximum comfort and safety of the patients. The OT is the major revenue source (around 50 -60%) for the hospital, therefore, it is advantageous for the hospital to optimize the efficiency of this area. The hospital measures the efficiency of operating theaters in diverse ways in terms of its ability to transform readily available time into earnings. This demands a high quantity of resources and efficient management to verify a well –functioning OT to meet the needs of OT staff, surgeons and to satisfy the hospital patients. In reality, to improve and enhance the effectiveness of operation theaters is a difficult process due to changing health facilities and administration. The quality data is required for evaluation of the performance of OT. However, many hospitals are facing the challenge in maintaining quality information and data required for proper evaluation and monitoring of OT performance. This indicates the need of constant management of OT working in a hospital to enhance the surgical output. In recent years, utilization of operation theaters has gained momentum and had been a priority area for hospital administrators as a measure of efficiency. Utilization of OT is an easy and adequate measure of the theater efficiency and has the capability to create revenue (efficiency increases) as the number of hours for which it is employed increases
OT Utilization can be defined as the measure of hours of theater time that is actually utilized during elective resource hours and also considers the total number of optional resource hours available for use for optimal utilization of theater time (Augusto et al., 2010). The existing study concentrates on understanding the pattern and course of Utilization of operation theatre of Satguru Pratap Singh (SPS) Hospital in Ludhiana district of Punjab. The surgical suite typically consumes a lot of the hospital budget. Operation theater is the department of the hospital where a high cost is incurred. There is a scarcity of data in India on the use of available operating time and the reasons for less than optimal utilization have not been studied.
In order to improve the utilization of operating room, it is essential to know how much time is spent on each of the activities. Since SPS Hospital is JCI accredited hospital, it has reasonably become a center of high activity. It is providing a wide range of operative services, right from basic General Surgery, Cardiac Surgery, ENT surgery, Plastic, Gynecological, Orthopedics & Ophthalmic to super specialty surgical work like Neurosurgical, Gastrointestinal & Laparoscopic & Urological work. SPS Hospital is also providing round the clock emergency services. The surgical suite typically consumes a lot of the hospital budget. Operation theater is the department of the hospital where a high cost is incurred. The utilization of operation theater will not be achieved if the resources are not used effectively. Effective management is necessary for making the operation theater efficient to meet the high revenue generation for the hospital and improving the patient flow and reducing the waiting list. Optimal use of the capacity of operation theater can be achieved by proper scheduling, proper timing, and adherence to the SOP’s of the hospital. It is imperative that the operation theater is an important department which can give most of the revenue to the hospital if properly utilized.
To assess the different types of surgeries and overall utilization of the OT, the present study was considered. This report also suggests the hospital for improving the utilization of operation theater further. The establishment renders super-specialty services for a range of medical and surgical fields. Satguru Partap Singh Apollo Hospitals is a center of excellence for Cardiac Sciences (cardiac surgery & interventional cardiology), Neuro Sciences (neurology & neurosurgery), Orthopedics and Joint Replacements, Gastro Sciences (gastroenterology and gastrointestinal surgery), Kidney Transplants, Mother and Child Care, Emergency Services and Preventive Healthcare Services.
The hospital has seven OT complexes. These theaters are equipped to handle all surgical cases for the above surgical departments. These theaters are scheduled for six days a week except for public holidays from 9:00 A.M. to 5:00 AM. Scheduling of cases for operation theaters is the closed type of scheduling i.e. OT tables fixed for specific departments. Scheduled cases are usually elective surgeries, though rarely emergencies are performed in scheduled time. Apart from scheduled cases sometimes few surgeries both electives and emergencies are performed, usually referred as unscheduled surgeries.
CHAPTER TWO
REVIEW OF LITERATURE
The utilization of operation theatre is not a new concept for healthcare establishments. In late 1970, the theory of OT utilization exists in the surgical journalism. To satisfy the growing expectations of patients from the hospitals and accomplish the demands from staff, doctors and surgeons the hospitals requires a well-managed and full-functioning operation theatre to maximize the utilization of operation theatre. Cardoen et al. (2010) defines OT utilization as the measure of hours of OT time essentially used during non-compulsory resource hours and the overall number of non-compulsory resource hours available for utilization of the OT time.
Oh et al. (2011) states proper allocation of resources is required to maintain an effective functioning of an OT unit in a hospital. In the opinion of Peltokorpi et al. (2009), weekly analysis of recorded data for accurate records, setting up of operating room policy and regulations, implementation of approved procedures and the strict adherence to these policies are essential factors for an efficient functioning of an operating room. At the same time, Augusto et al. (2010) points that the frequent changes in the administration and health facilities makes the functioning and achieving effectiveness of an operation theatre a difficult procedure. It can be said that for the proper functioning of the operation theatre and for enhancing the level of surgical output in the hospital there is need for constant supervision with proper management of hours and effective allocation of the available resources.
The medical literature argues that leadership and management plays a significant role in the adequate functioning and development of an operation theatre. Researchers have indicated that the function of OT within a hospital also depends on provision of surgical and diverse medical services. These services are wide-ranging such as time utilizations, sterilization, equipment, control of infections, drugs, etc.
The studies on OT functioning and development revealed that the measure of time utilization of OT has been of great interest among various academicians and researchers. Time scheduling in operation theatre is useful to increase the OT efficacy in relation to requirement planning, ease of access to equipment and even working on the internal environment of a hospital. Furthermore, infection control and cost factor are essential in the planning of OT development or facility expansion.
CHAPTER THREE
RESEARCH METHODOLOGY
This chapter explains the design of the research, the process of collecting the information and related data to the topic under study. The methodology also describes how the collected data is analyzed that helps the researcher to explore the ways to overcome the challenges in the research problem. Research Methodology provides an overview on the used research methods, approaches and strategies for collecting, presenting and analyzing the data to accomplish the research objectives for the research study
AIM
To study the utilization of Operation Theatres in SPS Hospital, Ludhiana
OBJECTIVES
1. To assess the overall utilization of operation theaters in terms of hours
2. To assess the extent to which different departments are utilizing the allocated hours.
3. To identify the proportion of (unplanned or planned) of surgeries
4. To suggest measures to improve the utilization of the OT.
STUDY METHODOLOGY
1. The study on utilization of Operation Theater at SPS Hospital, Ludhiana is a
Descriptive type of study.
2. Data Analysis: Data was analyzed with the help of MS-Excel
RESEARCH TIMEFRAME
The period of study: From February 2017 to April 2017.
RESEARCH LIMITATION
1. There is no data available for the cancelation as well absenteeism of patient from planned surgeries.
2. There was no pre- scheduling done one day prior to the day of surgery so it added to poor utilization of O.T.
3. The unplanned surgeries done in emergency also affected the utilization as the surgery planned had to be delayed.