Drive for efficiency takes scalpel to costs

01:17, May 06 2013
Martin Anderson
The Productive Operating Theatre programme facilitator Martin Anderson and Charge Nurse Manager Monette Johnston.

A programme to increase surgical efficiency in Marlborough and Nelson reduced patient turnaround time and could allow for an extra three or four operations a week, programme manager Martin Anderson says.

With theatre time priced at $3000 an hour, it could save the health board more than $156,000 a year.

Early last year, the board was funded $350,000 by the Ministry of Health to implement an 18-month review of surgical theatre productivity, which would end in August.

The Productive Operating Theatre programme (TPOT) was created by the National Health Service in the United Kingdom.

The Nelson Marlborough District Health Board used the programme to overhaul its theatre departments - from more efficient use of theatre time, cutting down last-minute cancellations, and better signage in storage rooms.

The board must save between $6 million and $8m in the next financial year to balance its books.


Mr Anderson said any theatre sitting idle, with staff and equipment ready to go, was a sunk cost.

"By doing everything more efficiently, we should be able to squeeze out an extra three or four operations without bringing in more staff, more doctors, opening another theatre and all of that means more cost."

Saving money was not the main driver of the programme though, Mr Anderson said. "Any savings generated from the programme will be a by-product."

The Government made it clear it wanted more elective surgeries in New Zealand, up to 4000 more a year, across the country, he said. That was despite the Government providing no extra funding.

About 5000 public and private operations are done each year in Blenheim. The board shares its three theatres and one procedure room with the Churchill Private Hospital.

Wairau Hospital charge nurse manager Monette Johnston said hip and knee operations were already over-subscribed in Marlborough. Mr Anderson said that was a major concern for orthopaedic surgeons at Wairau Hospital.

Surgeons were already doing more operations than their contracted volume without getting paid for the extra workload.

Gains were also made by cutting the time spent looking for necessary theatre equipment, he said.

Ms Johnston said better signage and colour-coded storage rooms had made a huge impact on her daily routine.

"I'm no longer called away to find something and staff are less stressed," she said. "Before TPOT, there were three or four nurses nagging staff to put things away but now everyone has bought into it. When TPOT ends and Martin's role finishes, I would like to know who will carry [the programme] on."

Better labelling also made nurses aware of equipment costs, she said. "I heard that, in another health board, when nurses needed 500ml of saline they would use the 500ml bag to cut down on waste, when actually the 1 litre bag was cheaper. So we have the cost on labels so staff can make a decision based on what they need clinically and cost."

Another of TPOT's major goals was to reduce wasted resources that were the result of "day of surgery" cancellations.

The programme hadn't made much progress in cutting down cancellations though, he said.

"What they don't understand is that the theatre time is booked for them, the surgeon, anaesthetist and nursing staff are all booked, which means someone else could have been treated in that time, and instead all these resources are wasted.

"While there is usually good reason for patients not to attend on day of surgery, what we would like is some notice to allow us to reschedule the theatre time," Mr Anderson said.

Ms Johnston said the main reason for cancellations at Wairau Hospital over the past two months was patients failing to arrive without notifying the hospital.

The Marlborough Express