RT Journal Article
SR Electronic
T1 Surgical System Efficiency and Operative Productivity in Public and Private Health Facilities in Ethiopia: A Cross-Sectional Evaluation
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2200277
DO 10.9745/GHSP-D-22-00277
VO 12
IS 1
A1 Sibhatu, Manuel Kassaye
A1 Getachew, Edlawit Mesfin
A1 Bete, Dawit Yifru
A1 Gebreegziabher, Senedu Bekele
A1 Kumsa, Tsegaye Hailu
A1 Shagre, Mulatu Birru
A1 Merga, Kassa Haile
A1 Taye, Desalegn Bekele
A1 Bashir, Hassen Mohammed
A1 Yicheneku, Mikiyas Teferri
A1 Zewude, Wuletaw Chanie
A1 Ashuro, Akililu Alemu
A1 Ashengo, Tigistu Adamu
A1 Meshesha, Berhane Redae
YR 2024
UL http://www.ghspjournal.org/content/12/1/e2200277.abstract
AB Key FindingsIn both public and private health facilities in Ethiopia, more than 84% of operating tables were functional. However, surgical system efficiency was low at an average productivity of 2 surgeries per operating room table per day.Predefined surgical incision start time, a strong predictor of operative productivity, was reported in only 31% of facilities. Of the surgery incision times audited, nearly 20% were delayed.First-case incision start times before 9:00 am had a significant association with shorter in-hospital surgery wait times.Key ImplicationHealth organizations should monitor the productivity of surgical systems and introduce efficiency optimization tools to improve the timeliness and safety of surgical care.Background:Global and local health organizations track surgical system efficiency to improve surgical system performance using various efficiency metrics, such as operating room (OR) output, surgical incision start time (SIST), turnover time (TOT), cancellation rate among elective surgeries, and in-hospital surgery wait time. We evaluated the surgical system efficiency and factors affecting the efficiency in health facilities across Ethiopia.Methods:A cross-sectional study design with retrospective record review was used to evaluate the surgical system efficiency in 163 public and private health facilities in Ethiopia from December 2020 to June 2021. Experienced, trained surgical clinicians abstracted efficiency data from service registers and patient charts using a pretested tool. A bivariable and multivariable regression analysis was conducted.Results:In the study facilities, 84.11% of the operating tables were functional, and 68,596 major surgeries were performed. The aggregate OR output in both public and private health facilities was 2 surgeries per day per OR table. Operating productivity was shown to be affected by first-case SIST (P=.004). However, of the total 881 surgery incision times audited, 19.86% of the first-of-the-day elective surgeries started after 10:01 am. The SIST was strongly associated with an in-hospital wait time for surgery (P=.016). The elective surgery cancellation rate was 5.2%, and aggregate mean TOT was 50.25 minutes. The mean in-hospital surgery wait time was 45.40 hours, longer than the national cutoff for wait time. In a bivariable analysis, the independent variables that demonstrated association operating room productivity were then inputted into a multivariable regression analysis model. However, none of the predictor/independent variables showed significance in the multivariable regression analysis model.Conclusion:The volume of surgery and overall OR productivity in Ethiopia is low. This calls for concerted action to optimize OR efficiency and improve access to timely and safe surgical care in Ethiopia and other LMICs.