G.Y. Hyman1,3, M. Papathanasopoulos5, M. Kawonga4, M.D. Smith1,3,5 1University of the Witwatersrand, Surgery, Johannesburg, GAUTENG, South Africa 3Chris Hani Baragwanath Academic Hospital, Surgery, Johannesburg, GAUTENG, South Africa 4University of the Witwatsrsrand, School Of Public Health, Johannesburg, GAUTENG, South Africa 5University of the Witwatersrand, Faculty Of Health Sciences, Johannesburg, GAUTENG, South Africa
Introduction: Surgical backlogs demand innovative strategies to upscale surgical services within health systems. Operating Theatre utilization (TU) is a critical entry-point for addressing unmet surgical needs. This study evaluates TU across several hospitals using the newly- developed Operating Theatre Utilization Measurement (OTUM) tool.
Methods: This multicentre, prospective, cross-sectional study developed and administered the standardised OTUM survey tool from April-October 2022 to public hospital surgical managers in a defined health system. Data was input into REDCap for facility type, facility capacity, operating theatre designation, delays, procedure types, and workforce. Causes for non-functional theatres (NFTs), functional operating theatre (FOT) disuse and delays were evaluated. Data was analysed using Stata 17.0.
Results: Eleven (61.11%) hospitals participated, comprising 7714 inpatient beds (med= 343;IQR= 552), with 1.65%( n=127; med=6; IQR=10) designated critical care beds. Level 3 hospitals had 65.89%(n=5000) and 75.59%(n=96) of these bed types respectively. Of the 108 (med=7; IQR=8) OTs, 28.7% (n=31; med=3; IQR=3) were non-functional theatres (NFTs). Among FOTs, 57% (n=22; med=1; IQR=1) were 24-hour-OTs. Daytime-OT utilization rate was 69.97%(n=602;med=66.67%;IQR=20.24). 24-hour-OT utilization rate was 88.69% (n=447;med=100%;IQR=28.47). Regression analysis showed association between facility level and utilization rates (R2=0.130, p<0.05 for daytime OTs; R2=0.007, p=0.035 for 24-hour-OTs). Ninety percent (n=10) reported a need to increase 24-hour-OTs. 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. Standardized OT staffing teams were not established.
Conclusion: The current suboptimal utilization of limited human and capital resources in operating theatres is a barrier to overcoming the issue of surgical backlogs. The OTUM tool provides a pragmatic approach to monitor, evaluate and respond to suboptimal surgical service delivery and tackle health system inefficiencies.