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Time and motion studies of National Health Service cataract theatre lists to determine strategies to improve efficiency
  1. Harry W Roberts1,2,
  2. James Myerscough3,
  3. Simone Borsci4,
  4. Melody Ni4,
  5. David P S O’Brart1,2
  1. 1 Department of Ophthalmology, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
  2. 2 Department of Diabetes & Nutritional Sciences, King’s College London, London, UK
  3. 3 Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
  4. 4 Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
  1. Correspondence to Mr Harry W Roberts, Department of Ophthalmology, Guy’s and St. Thomas’ NHS Foundation Trust, London SE1 7EH, UK; harry.roberts{at}


Aim To provide a quantitative assessment of cataract theatre lists focusing on productivity and staffing levels/tasks using time and motion studies.

Methods National Health Service (NHS) cataract theatre lists were prospectively observed in five different institutions (four NHS hospitals and one private hospital). Individual tasks and their timings of every member of staff were recorded. Multiple linear regression analyses were performed to investigate possible associations between individual timings and tasks.

Results 140 operations were studied over 18 theatre sessions. The median number of scheduled cataract operations was 7 (range: 5–14). The average duration of an operation was 10.3 min±(SD 4.11 min). The average time to complete one case including patient turnaround was 19.97 min (SD 8.77 min). The proportion of the surgeons’ time occupied on total duties or operating ranged from 65.2% to 76.1% and from 42.4% to 56.7%, respectively. The correlations of the surgical time to patient time in theatre was R2=0.95. A multiple linear regression model found a significant association (F(3,111)=32.86, P<0.001) with R2=0.47 between the duration of one operation and the number of allied healthcare professionals (AHPs), the number of AHP key tasks and the time taken to perform these key tasks by the AHPs.

Conclusions Significant variability in the number of cases performed and the efficiency of patient flow were found between different institutions. Time and motion studies identified requirements for high-volume models and factors relating to performance. Supporting the surgeon with sufficient AHPs and tasks performed by AHPs could improve surgical efficiency up to approximately double productivity over conventional theatre models.

  • treatment surgery

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  • Contributors HWR and JM contributed to acquisition of data, analysis and interpretation of data. HWR, MN and SB contributed to analysis of data, and all authors contributed to drafting the article and revising it critically for important intellectual content.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.