I would be interested to hear peoples views on the Audit Commission report
widely publicised yesterday: "Operating Theatres - a bulletin for health
bodies" [1]. They were espousing in their press release and televised
interviews a big-numbers scare-story that if NHS operating theatres were
used efficiently, that they could process an additional 300,000 operations
per year.
I had a quick look at their report, and it concerned me that they are using
a value of 95% use of theatre time as an achievable and standard goal.
Although I'm not a mathematician, I understand that queuing theory predicts
that systems become unstable above 85% of maximum throughput. Adrian Bagust
and colleagues concluded a similar view of hospital throughput in work
published in the BMJ some years ago [2]. Further, I couldn't really see any
breakdown of their data by type of operating theatre, where routine elective
surgery would be, I presume, far more manageable and predictable than other
types of more sophisticated or emergency surgery. As far as I could see from
the quick look-see, they also failed to draw attention to other more
important rate limiting factors, such as staffing issues, limited bed
capacity, pressure from emergency medical admissions (particularly in
Winter), availability of other support services, and the availability of
social or home care slowing discharge from limited beds. I'm sure that there
are other possibly more obvious factors. Their general conclusion was that
we should have better information to assist management.
I felt that this was unfair. A conspiracy theorist - and I'm one of them -
could quite possibly conclude that this had more to do with self-publicity
for the Audit Commission than a serious effort to improve hospital
efficiency. My personal view is that this stuff is of no benefit, has no
scientific credibility, and helps undermine morale.
Regards, Craig
Dr Craig Currie
Cardiff Research Consortium
Medicentre
Heath Park
Cardiff CF14 4UJ
Phone: 44(0)2920682047
Fax: 44(0)2920750239
Mobile:44(0)7771662115
[1] http://www.audit-commission.gov.uk/news/prdaoptheatres.shtml
[2] Adrian Bagust, Michael Place, John Posnett. Dynamics of bed use in
accommodating emergency admissions: stochastic simulation model. BMJ
1999;319:155-158
[http://bmj.com/cgi/content/full/319/7203/155?view=full&pmid=10406748]
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