Where the time goes between operations
A changeover looks like one block of time on a theatre list. Inside it are four separate waits, and they need different fixes.
NHS Improvement estimated in 2019 that around 291,000 more operations a year could fit into England's theatres with better use of time. Some of that is lists starting late or finishing early. A large part sits in the gap between one patient leaving and the next arriving.
That gap is usually reported as a single number: turnaround time. A single number is hard to act on. Break it down and the picture changes.
1. Waiting for the next team to hear
When surgery ends, recovery, the cleaning team and the porter often find out one after another: someone puts their head round the door, or makes a phone call when they get a moment. Every minute between "surgery is finished" and "the next team knows" is a minute nobody is working on the changeover.
2. Cleaning
Cleaning is real work and it should not be rushed. The question is whether it starts the moment the patient leaves, or ten minutes later because the cleaners were never called.
3. Setting up
Laying out the next set of instruments and checking equipment. This is usually the most predictable part, because the scrub team controls it.
4. Waiting for the next patient
The room is ready, and the team waits. The patient may still be on the ward, the porter may be with another theatre, or the paperwork may not be finished. In many changeovers this is the longest wait of all, and it is invisible unless someone writes the times down.
An example. In the example case on our site, a 30-minute changeover against a 20-minute target included 16 minutes of waiting. The cleaning and set-up themselves were close to target. Speeding up the cleaners would not have helped. Calling the porter earlier would have.
Which one to fix first
Measure all four for two weeks before changing anything. The longest wait is usually a hand-off, not a task, and hand-offs are the cheapest thing to fix: they need the right person to know at the right moment, not more staff.
Getting It Right First Time (GIRFT) sets a target of 85% touchtime: the share of a list spent from the start of anaesthesia to the patient leaving theatre. Shorter waits between cases are one of the most direct ways to move towards it.
How ORbserve helps
ORbserve times each of the four parts from a camera, with nothing typed in, and calls recovery, cleaning and the porter together once closure is confirmed. After each changeover, the report names the biggest wait. Request a demo.