OPTIMIZING THEATRE UTILISATION TO SCALE UP PLANNED ESSENTIAL SURGERY: THE DEVELOPMENT AND APPLICATION OF THE OPERATING THEATRE UTILISATION MEASUREMENT (OTUM) TOOL IN SOUTH AFRICA gabriellahyman@gmail.com

 

OPTIMIZING THEATRE UTILISATION TO SCALE UP PLANNED ESSENTIAL SURGERY: THE DEVELOPMENT AND APPLICATION OF THE OPERATING THEATRE UTILISATION MEASUREMENT (OTUM) TOOL IN SOUTH AFRICA

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South Africa

Oral or Poster

The problem of delays to planned essential surgery(PES)-“backlogs”- is leading to increasing political and public pressure for health planners, researchers and providers to find innovative strategies to scale up surgical services. Theatre utilisation(TU) is a critical entry-point for addressing unmet surgical needs. This study evaluates TU in South Africa’s public healthcare system.

This multi-centre, prospective, cross-sectional study developed and administered the newly Operating Theatre Utilisation Measurement(OTUM) tool to surgical managers in a defined health system in South Africa. Data were collected using REDCap for domains spanning facility information, Operating Theatre(OT) designation, delays, performance, procedure types, and workforce. Case volume was collected from OT logbooks. Causes for non-functional theatres(NFTs), functional operating theatre(FOTs) disuse and delays were evaluated. Data were analysed using Stata.v.17.0.

Eleven(61.11%) hospitals participated, comprising 7714 inpatient beds (med=343;IQR=552), with 1.65%(n=127;med=6; QR=10) critical care beds. Tertiary hospitals had 65.89%(n=5000) and 75.59%(n=96) of these respectively. Of the 108(med=7;IQR=8) OTs, 28.7% (n=31; med=3; IQR=3) were NFTs. Among FOTs, 57% (n=22; med=1; IQR=1) were 24-hour-OTs. Daytime- and 24-hour-OT utilisation rates were 69.97%(n=602;med=66.67%;IQR=20.24) and 88.69% (n=447;med=100%;IQR=28.47) respectively. Regression analysis showed association between facility level and utilisation rates(daytime OTs:R2=0.130, p<0.05; 24-hour-OTs:R2=0.007, p=0.035). Tertiary hospitals provided 58.3%(n=22727) of procedures(med=6146;IQR =3854) and District hospitals 16.5%(n=6426;med=1069; IQR =1104), with significant differences across levels(χ²(2)=7.64;p =0.022). Only emergency obstetrics was offered 24/7 by all facilities. Barriers included infrastructure(30.77%;n=8),26.92%(n=7) workforce, and 19.23%(n=5) equipment.

Suboptimal utilisation of limited human and capital OT resources exacerbates PES backlogs. The OTUM tool provides a pragmatic approach to monitor, evaluate and mitigate surgical system inefficiencies.