The effect of overlapping surgical scheduling on operating theatre productivity: a narrative review

Abstract

This article reviews the background to overlapping surgery, in which a single senior surgeon operates across two parallel operating theatres; anaesthesia is induced and surgery commenced by junior surgeons in the second operating theatre while the lead surgeon completes the operation in the first. We assess whether there is any theoretical basis to expect increased productivity in terms of number of operations completed. A review of observational studies found that while there is a perception of increased surgical output for one surgeon, there is no evidence of increased productivity compared with two surgeons working in parallel. There is potential for overlapping surgery to have some positive impact in situations where turnover times between cases are long, operations are short (<2 h) and where 'critical portions' of surgery constitute about half of the total operation time. However, any advantages must be balanced against safety, ethical and training concerns.

Keywords: operating theatre efficiency; operating theatre scheduling; patient safety; quality improvement.

Figure 1

Data from Padegimas et al. [17] for their examples of (a) two parallel, independent operating lists (Theatre 1 (red) and Theatre 2 (blue)) each with three cases of 3‐h duration and a turnover time between cases of 45 min and (b) an overlapping model where the Theatre 1 (red) list resembles that in (a) and the cases in the Theatre 2 (blue) list are staggered such that anaesthesia commences to enable the senior surgeon from the Theatre 1 (red) list to start Theatre 2 (blue) surgery after the critical portion in Theatre 1 (red) is complete. Note that this overlapping model can, within the time available, only deliver four completed cases vs. six in the conventional model shown in (a). [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 2

Two hypothetical 9‐h lists (Theatre 1 (red) and Theatre 2 (blue)), conventionally scheduled, with duration of each operation 150 min and turnover 30 min. The times of operations (start and end) are shown and as a percentage of the total scheduled list time. The performance metrics are shown in Table 1. [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 3

Two hypothetical 9‐h lists (Theatre 1 (red) and Theatre 2 (blue)), with overlapping scheduling, with duration of each operation 150 min and turnover 30 min. The times of operations (start and end) are shown. The performance metrics are shown in Table 2. [Colour figure can be viewed at wileyonlinelibrary.com]