Time and motion modelling of immediately sequential bilateral cataract surgery (ISBCS) in a public healthcare system: possible improvements in surgical efficiency based on existing time-and-motion studies

Session Details

Session Title: Cataract
Session Date/Time: Friday 21/02/2020 | 10:30-13:00
Paper Time: 11:06
Venue: Fes 1.

First Author: H.Roberts UK
Co Author(s): M. Ni  D. O'Brart              

Abstract Details

Purpose:

Immediately sequential bilateral cataract surgery (ISBCS) has been shown to be cost effective in terms of in-patient care, patient travel, home care and loss of working time costs. It also offers the ability to improve Operating Room (OR) efficiency compared with unilateral cataract surgery, by reducing patient OR transfer and preparation times, whilst ensuring that requirements for safety are undertaken. Such improvements in OR time efficiency, have the potential to increase OR utilisation by allowing more cataract cases to be treated within a given time. To investigate this, we modelled the potential increased productivity that may be achieved with ISBCS.

Setting:

Guys and St Thomas' Hospitals NHS Foundation Trust West Suffolk NHS Foundation Trust Southend University Hospital NHS Foundation Trust Norfolk & Norwich University Hospital NHS Foundation Trust BMI Southend Private Hospital

Methods:

Previously published “time and motion” data of unilateral cataract surgery within the OR at five UK institutions were analysed. The collected data was used to construct a hypothetical model where only ISBCS (± one unilateral case) was conducted while maintaining the time duration of all key tasks studied. Total patient time in theatre was calculated for each ISBCS. Predicted increase in numbers of eyes operated on and percentage increase were calculated for the five NHS settings. Gains in efficiency were correlated with factors from the baseline data to predict which settings could improve efficiency most by undertaking routine ISBCS.

Results:

The mean total duration of patient time in theatre for ISBCS was modelled at 30.52 ± 9.94 minutes. Based on our documented timings and the baseline duration of theatre activity, all five settings showed that an increase in number of eyes operated on was possible, with a baseline range of 6 to 13.5 eyes per list for unilateral surgery to 8 to 18 eyes per list with ISBCS. The median possible increase in number of cataract surgeries performed with ISBCS was 3 eyes (range 1-5) or a 32% (range 9-38%) increase in case numbers.

Conclusions:

ISBCS has the potential to increase the efficiency of NHS cataract services with more cases performed during a given theatre session. Despite that all studied NHS settings were predicted by the model to increase numbers of total cases performed with ISBCS, there was a variability in predicted increased operations with some units benefitting more than others, typically in units where more cases were already being performed. Further work is required to test theatre utilisation in ISBCS in a real-world setting.

Financial Disclosure: