A Survey of the Factors Affecting Theatre Turnaround Time in Kenyatta National Hospital Main Theatres

Abstract

Introduction: Operation theatres are essential departments in health facilities, responsible for the surgical care of patients. They are some of the most heavily budgeted departments. Monitoring processes that ensure that the systems are efficient in theatres is instrumental. One key process is Turnaround time (TAT). It is a significant determinant of patient care efficiency, improved service delivery and effective utilization of hospital revenues. This study aimed to determine the factors affecting turnaround time in Kenyatta National Hospital's main theatres. Methodology: This was a descriptive observational study carried out over 7 weeks (6th September 2021 to 25th October 2021). It was conducted on 400 staff in KNH main theatres using the proportionate stratified sampling method. The staff included were all working in KNH main theatres and postgraduate students from the University of Nairobi practising in main theatres. The data collected indicated variables related to different factors affecting TAT in KNH such as the personnel, surgical, equipment and consumable factors, and infrastructural factors. Data was collected using researcher-assistant semi-structured questionnaires as well as digital administration using the KoBo Toolbox. The data was analyzed using STATA and Statistical package for social sciences (SPSS) version 24.0. Descriptive statistics was used to give overall insights of variables corresponding to factors affecting TAT. The chi-square tests indicated the bivariate associations between TAT estimates and different factors such as personnel, surgical and infrastructural factors. The multinomial regression model was used to conduct multivariate analysis to identify each factor's significance to the TAT in the main theatres. A p-value of 0.05 was considered significant for all the tests. Results were presented in frequency tables, bar charts and pie charts. vii Results: A total of 400 staff participated in the study where N= 231, 57.75% were male, while N=169, 42.25% were female. The Chi-square tests of association indicated a significant relationship between personnel factors, surgical factors, equipment and consumable factors with TAT in KNH main theatres (p<0.05). According to the multinomial regression analysis, the personnel factors that have a significant influence on TAT include: prolonged nursing handover time (p=0.000, <0.05), staff shortage (p=0.039, <0.05), and lack of support of the theatre managers (p=0.020, <0.05). The surgical factors that have significant influence on TAT include: urgency of surgery (theatre preparation for emergency surgery versus elective surgery) (p=0.025, <0.05) and lack of efficient and adequate response of blood transfusion units during surgery (p=0.000, <0.05). The equipment and consumable factors that affect TAT significantly include: adequacy of anaesthesia machines to cater for patients (p=0.019, <0.05), adequacy and reliability of supply of anaesthetic drugs (p=0.041, <0.05), adequacy in number of stretchers and wheelchairs (p=0.022, <0.05) and lack of adequacy and reliability of supply of drapes and gowns (p=0.019, <0.05). Lastly, the infrastructural factors that have significant influence on TAT include: adequacy and reliability of electricity supply (p=0.011, <0.05), lack of adequacy and reliability of oxygen supply (p=0.023, <0.05), and lack of ease of accessibility of the main theatres from the surgical wards and ICU (p=0.000, <0.05). All the infrastructural factors were significantly associated with TAT, apart from the adequacy and reliability of water supply (p=0.412, >0.05), PACU sufficiency for accommodation of patients post operatively (p=0.577, > 0.05) and availability of ICU space for deserving surgical patients (p=0.401, >0.05). In open ended responses, few number of patient porters, consultant surgeons’ delay in joining junior surgeons/registrars during complicated surgeries; and inadequate number of lifts with habitual malfunctions were observed to cause delays in between surgeries in KNH main theatres. viii Conclusion: Personnel factors: prolonged nursing handover time during shift change, lack of supportive theatre managers, staff shortage and delays by consultant surgeon in joining junior surgeons/registrars during complicated procedures increased TAT time in KNH main theatres. There exists no significant association between staff insufficient qualification for their jobs, inadequately met staff training needs, lack of staff motivation, staff not being highly overworked, lack of lateness to workplace, absconding from work by staff, good teamwork among staff, and TAT in KNH main theatres. Surgical factors: nature of the urgency of the surgery (theatre preparation for emergency surgery versus elective surgery) and lack of efficiency and adequacy of response of blood transfusion units during surgery increased TAT. There exists no significant association between adequacy in number of surgical sets for surgery, patient being prepared well for surgery preoperatively and TAT in KNH main theatres. The equipment and consumable factors: lack of adequacy and reliability of supply of drapes and gowns increased TAT in KNH main theatres. The variables that caused decreased TAT include: availability of enough anaesthesia machines to cater for patients, adequacy and reliability of supply of anaesthetic drugs and adequacy in number of stretchers and wheelchairs for patient transport. Lack of adequacy and reliability of laboratory support for patients had no significant influence on TAT. Infrastructural factors: lack of adequacy and reliability of oxygen supply, lack of ease of accessibility of main theatres from the surgical wards and ICU; and inadequate number of lifts with habitual malfunctions increased TAT. There exists no significant association between availability of ICU space for deserving surgical patients, PACU space sufficiency to accommodate patients post operatively, adequacy and reliability of water supply; and TAT in KNH main theatres