Key Surgical System Efficiency Indicators Adapted From the Saving Lives Through Safe Surgery Program in Ethiopia, 2016–2020

IndicatorsDescriptionClassification or Benchmark
OR productivityaDefinition: Total count of major, elective, and emergency surgeriesb performed in a health facility in target OR rooms/tables during the study period (i.e., 10 working days), excluding surgeries booked but canceled. Working schedule for elective surgeries is Monday–Friday, but the start times may vary. For this study, we used 6:00 am as the time when the night shift ends. Official work start time for civil servants is 8:30 am.Optimum: ≥2 surgeries per day in a major OR
Functional operating tableDefinition: A surgical table actively used by the surgical team in an OR during the study period (i.e., 10 working days). Nonfunctioning OR/table is an operating room that has been closed or a room/table that has not been used for a major surgery in the previous 10 days each day during the study period.Functional: available for surgery 24 hours a day, 7 days a week
SISTDefinition: A time record for surgical incision of an elective surgical procedure scheduled for the first patient in a typical operation day (also known as a pacemaker case). In this study, the OR day starts at 6:00 am. A retrospective audit of SIST (HH:MM) was conducted by taking 10 randomly selected charts of the first-case surgery performed in the previous 90-day study period. Predefined SIST is a facility-defined specific time for first-case SIST, in writing, or communicated to surgical teams on the same.

Early, earlier than 9:00 am.

Late, 9:00 am or later

Turnover Time

The time lapse between 2 consecutive elective surgical procedures (i.e., the time difference between the first surgical case end time and the immediate next case). Incision start time was recorded on the surgical logbook or anesthesia sheet.

In this study, a retrospective chart review of 10 patient pairs (a total of up to 20 charts from each health facility) of consecutive post-surgical patients was conducted.

Acceptable: ≤30 minutes

Prolonged: >30 minutesc

Needs immediate improvement: >60 mins

Cancellation of elective surgeryA nonemergent surgical procedure that is booked for operation but did not enter the theater or could not be operated on that day for various reasons. Cancellation rate was calculated as the number of elective surgeries booked for a given operation day and not operated on (numerator) divided by the total number of elective surgeries scheduled for the same day (denominator).

Acceptable rate: <5%

Needs improvement: 5%–10%

Needs immediate improvement: >10%

In-hospital surgery waiting timeThe total duration of time lapsed from the time of admission to surgical wards until the recommended elective surgery, in the same facility. Not applicable for emergency surgery. A retrospective audit of time lapsed for individual surgical patients was conducted. Data aggregated for analysis and reporting purposes.

Timely, <24 hours

Delayed, ≥24 hours

  • Abbreviations: OR, operating room; SIST, surgical incision start time.

  • a In this study, OR productivity is synonymous with OR output.

  • b Major surgery is any intervention occurring in a hospital OR involving the incision, excision, manipulation, or suturing of tissue, usually requiring regional or general anesthesia or sedation in a health care setting; this excludes all minor surgeries. Elective surgery is a nonemergent surgical procedure that is indicated for medical, surgical, or reconstructive purposes and could be delayed for at least 24 hours.

  • c Turnover time longer than 30 minutes may indicate loss of surgical system efficiency and may indicate wastage of resources.