QA Study Presentation

7/27/2019 QA Study Presentation

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A Quality Assurance Study on

Reasons for Delay in the Daily Starting of theEmergency Theatre in Hospital Kuala Lumpur


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Introduction Objective

Methodology

Results Discussion


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The Emergency operating theatre functionsround the clock, 24hrs a day, 365 days ayear.

There are currently 6 emergency theatres

functioning in HKL General Surgery and Gynaecology Orthopaedics and Trauma Neurosurgery Urology Maternity Paediatric surgery


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Despite this abundance of operation theatres,there still exists a backlog in emergencycases postponed due to the lack of operatingtime.

Amongst the postulated reasons for this backlog was that there was a delay in the start ofthe emergency theatre causing wastage of

precious operating time As such this quality assurance study was

implemented to study these issues


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To ascertain whether the emergency theatrestarts on time

To study the reasons for the delay instarting the emergency cases, and

To institute remedial measures if necessary toimprove the emergency theatre services


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Time General OT

From November 2012 to January 2013

Peripheral OT

December 2012 to February 2013

Data collection was done via use of adesigned questionnaire Completed by the staff nurse in charge daily at each

emergency theatre location. The data that wascollected was then analysed and presented.


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Definitions Delay in starting Emergency surgery


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Overall The vast majority of days in the 3 months studied

had a delay in the start of the emergency theatre

However the reasons were varied, with the most

common being `No cases posted` This trend was seen not only in the GOT but also in

the peripheral OTs


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86.0%

67.7%

80.6%

14.0%

32.3%

19.4%

NOV-12

DEC-12

JAN-13

Percentage of Days with Delay in Starting theEmergency Theatre

Delay On Time


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No case posted Most frequent reason

Most cases postedafter rounds by

surgical team

Surgical Issues Surgeon unavailable

Uncontactable

Busy with rounds

Surgery pending reviewby surgeon


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AnaesthesiaIssues Unstable patient

Awaiting ICU Bed Anaes review in

wards

Awaiting medical

review

Case not passedover properly

Consent issues Patient refused op

No valid consent

Awaiting familyconsent

Incomplete consentforms

N 12 D 12 J 13


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ReasonsNov-12 Dec-12 Jan-13

% % %

1 No case 71.2 57.1 64.0

2 Patient refused op 4.8

3

Surgeon doing round 4.8

4.8

12.0

4 Case not pass over by on call team 4.8

5 Awaiting patient from the angio room 4.8

6 Awaiting mothers consent 4.8

7 Refer medical 4.8

8 Insufficient fasting time 14.1 4.0

9 Waiting for ICU bed 4.8

10 Anaes review patient in the ward 4.8 4.0

11 Surgeon review patient in the ward 4.8 4.0

12 Surgeon uncontactable 4.8

13 Unstable patient 4.8

14 Waiting for relative 4.0

15 Incomplete consent 4.0

16 Consent not available 4.0Total 100.0 100.0 100.0


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Month Dec 2012 Jan 2013 Feb 2013% of days with delay instarting at 8am 77.4% 58.0% 53.6%

There were no cases posted by 8 am for alldays that there was a delay in starting theemergency theatre


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Month Dec 2012 Jan 2013 Feb 2013% of days with delay instarting at 8am 44% 48.4% 46.4%

Once again the prevalent reason for the delaywas that there were no cases to be called.

There was a small percentage of days where thedelay was due to the patient being sent late to

OT Dec 2012 9.1% Jan 2013 6.7%


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Month Dec 2012 Jan 2013 Feb 2013% of days with delay instarting at 8am 100% 100% 100%

There were no cases posted by 8 am for alldays during the study.

Most emergency cases were posted only after

8am and as such the emergency theatrestarted after the cases were posted


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Month Dec 2012 Jan 2013 Feb 2013% of days with delay instarting at 8am 54.8% 64.5% 85.7%

Once again the most prevalent reason for thedelay was that there were no cases posted


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ReasonsDec-12Jan-13 Feb-13

% % %

1 No case 76.5 60.0 70.8

2 Surgeon doing rounds 5.9 30.0 29.2

3 Awaiting ICU Bed 5.9

4 Awaiting neuro team 5.9

5 Consent not available 5.9 5.0

6 Blood not available 5.0


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A wide variety of reasons were responsible forthe delay.

However most days the theatre started on

time

Month Dec 2012 Jan 2013 Feb 2013% of days with delay instarting at 8am 48.3 41.9 46.4


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Reasons

Dec-12 Jan-13 Feb-13

% % %

1 No Case 35.7 69.2 76.9

2 Awaiting Orthopaedic registrar 14.5

3 Insufficient fasting time 7.1

4 Delay in sending patient to OT 7.1

5 Surgeon attending CME 21.4

6 Anaes review patient in wards 7.1

7 Surgeon reviewing patient in wards 7.1

8 Awaiting interlocking set 15.49 Surgeon in meeting 7.7

10 Patient's dextrostix was high 7.7

11 Surgeon doing rounds 15.4

12 Mechanical malfunction of OT 7.7

Total 100.0 100.0 100.0


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The expected delay rate was at about 5%,however this was shown to be much higher inthis audit High prevalence of delay in starting the Emergency

Theatre Ranging from 41.9-100%

Variety of reasons, however the mostcommon was that there were no cases posted

by 8 am


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Amongst the other reasons given for thedelay, many of which were avoidable

Examples of avoidable reasons were Consent related

Fasting times Blood not available

These reasons should be rectified to reducethe delay

OT booking forms should be complete There should be proper checks before the booking

of an emergency operation with regards to theconsent and availability of blood


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There was a larger than expected delay instarting the emergency theatre, howevermost of the delay was unavoidable as therewere no cases posted to be called.

The OT booking form should be completedwell and sent early to enable better usage ofOT time

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