Transforming theatres.
Article Type: Viewpoint essay
Subject: Health care industry (Quality management)
Health care industry (Waste management)
Patients (Safety and security measures)
Pub Date: 04/01/2012
Publication: Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2012 Association for Perioperative Practice ISSN: 1750-4589
Issue: Date: April, 2012 Source Volume: 22 Source Issue: 4
Topic: Event Code: 353 Product quality; 420 Pollutants produced & recycled; 260 General services Computer Subject: Health care industry
Product: SIC Code: 8000 HEALTH SERVICES
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 293545455
Full Text: Since 2008 when the Saving 1000 Lives Campaign began in Wales, there has been a much greater focus on patient safety and the reduction of waste, harm and variation in care. The Campaign was hugely successful and since 2011 it has become the Welsh Government's flagship service improvement programme, now called 1000 Lives Plus.

The focus in 'Transforming Theatres' in 1000 Lives Plus is on using proven tools, techniques and methods to ensure theatres are running as efficiently as possible - benefitting patients, maintaining staff morale and reducing waste. Operating theatres are one of the most expensive resources in any hospital. But there are many opportunities to improve patient safety, productivity and efficiency. For example, data on theatre utilisation shows there are ways that theatres could be used more effectively. (For more information see website:

From 2008 to 2011, surgery started late in 22 per cent of all cases (on average). Similarly, from 2008-2011, the average percentage of theatre lists that finished early, that is more than 30 minutes before the agreed finish time, was 27.95%. So at the beginning and the end of theatre sessions, there was time lost that could have been used to treat patients.

Better list planning and scheduling will increase efficiency, but there are many ways to improve patient and staff experience of surgery, including many seemingly small changes that over time deliver significant value to everyone involved. Transforming Theatres teaches staff tools and techniques for improvement, including:

* Waste spotting

* The '5S' approach (Sort, Set, Shine, Standardise, Sustain)

* Activity mapping to determine how long certain activities take

* Operational status at a glance ('Visual Management')

Reducing costly wastage

Empty paracetamol bottles were disposed of in the theatres 'sharps bins'. They are now recycled. In addition to being better for the environment, there has been a significant cost-saving.

In one year one medium-sized hospital in Wales used 23,165 bottles of paracetamol in theatre, equating to 7,573kg of waste in the form of empty bottles.

Waste disposal in a sharps bin costs [pounds sterling]619 per metric ton. The cost of disposing of the empty paracetamol bottles was therefore [pounds sterling]4,688. In contrast, recycling disposal costs [pounds sterling]50 per metric ton. Recycling the paracetamol bottles costs [pounds sterling]379 per year.

The new recycling scheme therefore saves [pounds sterling]4,309 per year in just one hospital, for one particular common form of waste. Paracetamol usage has increased since 2009 so the savings are actually greater than this. Scaled up to every hospital, and for other waste packaging, the cost-savings could be hundreds of thousands of pounds.

Activity mapping

This procedure has been widely used on wards and is now being introduced into theatres. This is a genuine example from one ward where staff analysed the process involved in getting commodes for patients and disposing of the contents of used commodes. They mapped the process and then simplified it.

They reduced the number of steps that staff had to take from 40 to 16. If each step averaged 0.5 metres then the team walked 12 metres less each time they collected a commode. With commodes needed about 50 times per day that works out at about 600 metres saved per day, or 219 kilometres of unnecessary walking.

Similarly, by re-arranging the room to reduce the number of steps from 40 to 16, the team reduced the time taken to perform this task from 12 to 11 minutes. When added up, those 50 one minute savings a day add up to 304 hours over a whole year, which means more time available to spend on direct patient care.

Translating this methodology to the myriad of journeys required each day by theatre staff is making similar improvements in time management. Locating equipment in appropriate places close to where it is needed and co-locating it with other items that may be needed for given procedures is a simple process but one that needs considered thought to be most effective.

A national template

The 1000 Lives Plus approach is being used in a wide number of areas across Wales, not just theatres. The programme advocates a specific 'bottom up' approach which encourages front line staff to identify then work on making local improvements in service.


The methodology includes:

* identifying the problem

* making sure the changes made are improvements

* measuring the difference

* introducing change

* teamwork and leadership

* communicating with and involving staff

* spreading change

Guidance on the methodology has been distilled into a pocket-sized Quality Improvement Guide. A specific guide for nurses has also been published and is available on the 1000 Lives Plus website.


The main message to take from this work in Wales is that it is within the grasp of every nurse to make changes in their environment that will improve their working conditions and provide safer, better care for their patients. If you want to know more please contact the 1000 Lives Plus team.

Thoughts and reflections on issues of interest to perioperative practitioners

KEYWORDS Theatres / Planning / Patient Safety / Transforming theatres

Provenance and Peer review: Commissioned; Not peer reviewed; Accepted for publication March 2012.

* Professor Jean White Chief Nursing Officer (Wales), Welsh Government
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.

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