The Effect of the COVID-19 Pandemic on Theatre Efficiency, Lessons to be Learned for Subsequent Waves

Document Type : RESEARCH PAPER

Authors

1 Ashford and St. Peter’s Hospitals NHS Foundation Trust

2 1Ashford and St. Peter’s Hospitals NHS Foundation Trust 2 Intelligent Health Research Group, University of East London, London, UK

Abstract

Background: This study aims to demonstrate the impact of the COVID-19 pandemic on providing trauma services at 
our district general hospital. We aim to identify the impact on specific areas of theatre delay to help optimize theatre 
efficiency and generate better protocols and improve patient flow for future pandemic waves.
Methods: Patients who underwent orthopaedic trauma surgery at our hospital between July-August 2019 (preCOVID-19) and 2020 (first UK wave of COVID-19) were identified retrospectively and grouped by year of operation. 
Type of operation was recorded, including time for sending, anaesthetic induction, surgical preparation, operating time, 
and time for transfer to recovery. The two groups were compared for analysis.
Results: Case numbers were similar in both 2019 and 2020 (215vs.213 operations), with a similar proportion being 
hip fractures (39.1% and 36.6%), respectively. Median sending time (40vs.23 minutes, P <0.00001) and induction 
time (13vs.8 minutes, P<0.00001) were increased in 2020, a 74% and 63% increase compared to 2019, respectively. 
Median surgical preparation time (35vs.37 minutes, P=0.06) and operating time (56vs.50 minutes, P=0.16) were not 
statistically significant. Transfer time in 2020 (16vs.13 minutes, P<0.00001) was significantly increased. Overall case 
time increased in 2020 (2:40vs.2:11, P<0.00001) by 29 minutes.
Conclusion: COVID-19 had a significant impact on theatre efficiency in our hospital, causing multiple points of delay. 
As hospitals across the UK restart crucial elective services, focus should be given to maximizing theatre efficiency 
by providing rapid access COVID-19 testing for patients undergoing emergency surgery. We have proposed and 
implemented several steps for better theatre utilization. 
Level of evidence: IIIBackground: This study aims to demonstrate the impact of the COVID-19 pandemic on providing trauma services at 
our district general hospital. We aim to identify the impact on specific areas of theatre delay to help optimize theatre 
efficiency and generate better protocols and improve patient flow for future pandemic waves.
Methods: Patients who underwent orthopaedic trauma surgery at our hospital between July-August 2019 (preCOVID-19) and 2020 (first UK wave of COVID-19) were identified retrospectively and grouped by year of operation. 
Type of operation was recorded, including time for sending, anaesthetic induction, surgical preparation, operating time, 
and time for transfer to recovery. The two groups were compared for analysis.
Results: Case numbers were similar in both 2019 and 2020 (215vs.213 operations), with a similar proportion being 
hip fractures (39.1% and 36.6%), respectively. Median sending time (40vs.23 minutes, P <0.00001) and induction 
time (13vs.8 minutes, P<0.00001) were increased in 2020, a 74% and 63% increase compared to 2019, respectively. 
Median surgical preparation time (35vs.37 minutes, P=0.06) and operating time (56vs.50 minutes, P=0.16) were not 
statistically significant. Transfer time in 2020 (16vs.13 minutes, P<0.00001) was significantly increased. Overall case 
time increased in 2020 (2:40vs.2:11, P<0.00001) by 29 minutes.
Conclusion: COVID-19 had a significant impact on theatre efficiency in our hospital, causing multiple points of delay. 
As hospitals across the UK restart crucial elective services, focus should be given to maximizing theatre efficiency 
by providing rapid access COVID-19 testing for patients undergoing emergency surgery. We have proposed and 
implemented several steps for better theatre utilization. 
Level of evidence: III

Keywords

References

1. Bhangu A, Lawani I, Ng-Kamstra JS, Wang Y, Chan 
A, Futaba K et al. Global guidance for surgical care 
during the COVID-19 pandemic. The British journal of 
surgery. 2020; 107(9): 1097–1103. 
2. Nepogodiev D, Bhangu A, Glasbey JC, Li E, Omar 
OM, Simoes JF et al. Mortality and pulmonary 
complications in patients undergoing surgery with 
perioperative SARS-CoV-2 infection: an international 
cohort study. The Lancet. 2020; 396(10243): 27-38.
3. COVID-19: Good Practice for Surgeons and Surgical 
Teams [Internet]. [Place Unknown]: Royal College of 
Surgeons of England; 2020 [updated 2020 April 3; 
cited 2020 Nov 11]. Available from: https://www.
rcseng.ac.uk/standards-and-research/standardsand-guidance/good-practice-guides/coronavirus/
covid-19-good-practice-for-surgeons-and-surgicalteams/ 
4. Sobti A, Fathi M, Mokhtar MA, Mahana K, Rashid MS, 
Polyzois I et al. Aerosol generating procedures in 
trauma and orthopaedics in the era of the Covid-19 
pandemic; What do we know?. The Surgeon. 2021; 
19(2): e42-e48.
5. Karia M, Gupta V, Zahra W, Dixon J, Tayton E. The effect 
of COVID-19 on the trauma burden, theatre efficiency 
and training opportunities in a district general 
hospital: planning for a future outbreak. Bone & Joint 
Open. 2020; 1(8): 494-9.
6. Zahra W, Karia M, Rolton D. The impact of COVID-19 
on elective and trauma spine service in a district 
general hospital. Bone & Joint Open. 2020; 1(6): 281-
6.
7. COVID-19: Guidance for the Remobilisation of 
services within health and care settings. Infection 
prevention and control recommendations [Internet]. 
[Place Unknown]: Public Health England; 2020 
[updated 2020 Aug 20; cited 2020 Nov 11]. Available 
from: https://assets.publishing.service.gov.uk/
government/uploads/system/uploads/attachment_
data/file/954690/Infection_Prevention_and_
Control_Guidance_January_2021.pdf
8. BOA Guidance update on Aerosol Generating 
Procedures (AGPs) [Internet]. [Place Unknown]: 
British Orthopaedic Association; 2020 [updated 2020 
July 2; cited 2020 Nov 11]. Available from: https://
www.boa.ac.uk/uploads/assets/89888385-996d470e-9772d2f061ba55ba/BOA-Guidance-update-onAGPs-FINAL.pdf
9. Delaney C, Davis N, Tamblyn P. Audit of the utilization 
of time in an orthopaedic trauma theatre. ANZ Journal 
of Surgery. 2010; 80(4): 217–22.
10.Fletcher D, Edwards D, Tolchard S, Baker R, Berstock 
J. Improving theatre turnaround time. BMJ Open 
Quality. 2017; 6(1): u219831-w8131.
11.Sadighi M, Mortazavi SMJ, Ebrahimpour A, ManafiRasi A, Ebrahimzadeh MH, Jafari KafiAbadi et al. 
Fracture Surgery in Known COVID-19 Infected 
Patients: What Are the Challenges? Arch Bone Jt Surg. 
2020; 8(3): 378-382. 
The Archives of Bone and Joint Surgery
Volume 10, Issue 4
April 2022
Pages 353-357

Files

History

  • Receive Date: 01 May 2021
  • Revise Date: 04 June 2021
  • Accept Date: 21 August 2021
  • First Publish Date: 30 August 2021

Share

How to cite

Statistics