A Quality Assurance Study on Reasons for Delay in the Daily Starting of the Emergency Theatre in Hospital Kuala Lumpur

Introduction Objective Methodology Results Discussion

The Emergency operating theatre functions round the clock, 24hrs a day, 365 days a year. There are currently 6 emergency theatres functioning in HKL
General Surgery and Gynaecology Orthopaedics and Trauma Neurosurgery Urology Maternity Paediatric surgery

Despite this abundance of operation theatres, there still exists a backlog in emergency cases postponed due to the lack of operating time. Amongst the postulated reasons for this back log was that there was a delay in the start of the emergency theatre causing wastage of precious operating time As such this quality assurance study was implemented to study these issues

To ascertain whether the emergency theatre starts on time To study the reasons for the delay in starting the emergency cases, and To institute remedial measures if necessary to improve the emergency theatre services

Time
General OT
From November 2012 to January 2013

Peripheral OT
December 2012 to February 2013

Data collection was done via use of a designed questionnaire

Completed by the staff nurse in charge daily at each emergency theatre location. The data that was collected was then analysed and presented.

Definitions
Delay in starting Emergency surgery

Overall
The vast majority of days in the 3 months studied had a delay in the start of the emergency theatre However the reasons were varied, with the most common being `No cases posted` This trend was seen not only in the GOT but also in the peripheral OTs

Percentage of Days with Delay in Starting the Emergency Theatre

Delay On Time

JAN-13

80.6%

19.4%

DEC-12

67.7%

32.3%

NOV-12

86.0%

14.0%

No case posted
Most frequent reason Most cases posted after rounds by surgical team

Surgical Issues
Surgeon unavailable
Uncontactable Busy with rounds Surgery pending review by surgeon

Anaesthesia Issues
Unstable patient Awaiting ICU Bed Anaes review in wards Awaiting medical review Case not passed over properly

Consent issues
Patient refused op No valid consent
Awaiting family consent Incomplete consent forms

Reasons
1 2 3 4 5 6 No case Patient refused op Surgeon doing round Case not pass over by on call team Awaiting patient from the angio room Awaiting mothers consent Refer medical Insufficient fasting time Waiting for ICU bed Anaes review patient in the ward Surgeon review patient in the ward Surgeon uncontactable Unstable patient Waiting for relative Incomplete consent Consent not available Total

Nov-12 % 71.2 4.8 4.8 4.8 4.8 4.8

Dec-12 % 57.1 4.8

Jan-13 % 64.0 12.0

7 8 9 10 11 12 13
14 15 16

4.8 14.1 4.8 4.8 4.8 4.8 4.8

4.0 4.0 100.0 100.0 4.0 100.0

4.0 4.0 4.0

Month % of days with delay in starting at 8am

Dec 2012 77.4%

Jan 2013 58.0%

Feb 2013 53.6%

There were no cases posted by 8 am for all days that there was a delay in starting the emergency theatre

Month % of days with delay in starting at 8am

Dec 2012 44%

Jan 2013 48.4%

Feb 2013 46.4%

Once again the prevalent reason for the delay was that there were no cases to be called. There was a small percentage of days where the delay was due to the patient being sent late to OT
Dec 2012 9.1% Jan 2013 6.7%

Month % of days with delay in starting at 8am

Dec 2012 100%

Jan 2013 100%

Feb 2013 100%

There were no cases posted by 8 am for all days during the study. Most emergency cases were posted only after 8am and as such the emergency theatre started after the cases were posted

Month

Dec 2012 54.8%

Jan 2013 64.5%

Feb 2013 85.7%

% of days with delay in starting at 8am

Once again the most prevalent reason for the delay was that there were no cases posted

Reasons 1 2 3 No case Surgeon doing rounds Awaiting ICU Bed

Dec-12 Jan-13 Feb-13 % 76.5 5.9 5.9 % 60.0 30.0 % 70.8 29.2

4
5 6

Awaiting neuro team

Consent not available Blood not available

5.9
5.9 5.0 5.0

Month

Dec 2012

Jan 2013

Feb 2013

% of days with delay in starting at 8am

48.3

41.9

46.4

A wide variety of reasons were responsible for the delay. However most days the theatre started on time

Reasons 1 2 3 4 5 6 7 8 9 10 11 12 No Case Awaiting Orthopaedic registrar Insufficient fasting time Delay in sending patient to OT Surgeon attending CME Anaes review patient in wards Surgeon reviewing patient in wards Awaiting interlocking set Surgeon in meeting Patient's dextrostix was high Surgeon doing rounds Mechanical malfunction of OT

Dec-12 % 35.7 14.5 7.1 7.1 21.4 7.1 7.1

Jan-13 % 69.2

Feb-13 % 76.9

15.4 7.7 7.7 15.4 7.7 Total 100.0 100.0 100.0

The expected delay rate was at about 5%, however this was shown to be much higher in this audit
High prevalence of delay in starting the Emergency Theatre Ranging from 41.9-100%

Variety of reasons, however the most common was that there were no cases posted by 8 am

Amongst the other reasons given for the delay, many of which were avoidable Examples of avoidable reasons were
Consent related Fasting times Blood not available

These reasons should be rectified to reduce the delay

OT booking forms should be complete There should be proper checks before the booking of an emergency operation with regards to the consent and availability of blood

There was a larger than expected delay in starting the emergency theatre, however most of the delay was unavoidable as there were no cases posted to be called. The OT booking form should be completed well and sent early to enable better usage of OT time