Clinically appropriate time to theatre

Clinically appropriate time to theatre

The aims of the Clinically Appropriate Time to Theatre project are:

  • to reduce the average time from when a patient is booked for theatre to when they arrive in theatre by 50%
  • to develop agreed metrics on clinically appropriate time to surgery and formal prioritisation process
  • that 80% of patients are operated on in the appropriate clinical time frame


There are two types of surgery, elective (planned) and acute (urgent or unexpected). Acute surgery is for situations such as a bone fracture or appendicitis and accounts for over half of all operations completed in our theatres at North Shore Hospital. It has a highly variable workload with estimated operating workload hours on a given day ranging from 15 to 45 hours.

We need to better understand the demand for different types of acute surgery and develop a standardised process for prioritisation of acute patients to ensure they are getting to theatre within the right timeframe for their condition.

What did we find?

  • Between 1st of October and 29th of November 2014, North Shore Hospital acute theatres performed 1923 procedures across all specialties
  • We were unable to determine what proportion of patients waited a clinically inappropriate length of time for surgery
  • Historically, referrals to theatre were made by completing a paper form and faxing this to our theatre. This did not provide us with an overview of the number of patients on the waiting list, the types of surgery required, and their clinical conditions

What did we do?

1. Acute patient prioritisation

We developed a tool to guide prioritisation of patients for acute surgery for time to theatre from booking based on their clinical presentations, eg E0 = within 15 minutes, E4 = within 4 hours, up to E24 = within 24 hours.

For patients who require more specialist input (eg spine) or whose clinical condition means that they are not fit for surgery (eg reduced swelling required for a fractured ankle) are categorised as ‘Acute Arranged’ patients and are scheduled for surgery after 24 hours.

2. Electronic booking form for theatre

We developed and introduced an electronic booking form for theatre which included our prioritisation tool.

Initial results following implementation of the electronic form show that (excluding ‘Acute Arranged’):

  • average time from booking for theatre to arrival in theatre is 14.18 hours
  • percentage of operations meeting clinically appropriate timeframe is 59.37%

Where to from here?

  • We want to ensure patients are appropriately prioritised on the electronic booking form
  • We will review existing processes to identify all possible causes for not meeting appropriate time to theatre and work to reduce / eliminate these causes

This project forms part of our overarching Acute Theatre Redesign programme.

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