2 The scope for better theatre management
and control
10. The C&AG's Report shows that there is considerable
scope for improvement and restructuring of theatre service management
and control in Northern Ireland's acute hospitals, recommending
that all theatre departments should have a theatre manager with
sufficient seniority and authority to review regularly how theatres
are being used by clinicians, and to ensure that theatre users'
committees develop their key role in ensuring the effective use
of theatres.[15] Systems
for the planning and monitoring of theatre activity in most acute
hospitals were found to be basic, paper-based, labour intensive,
and limited in their capacity, with the data collection and reporting
on theatre use, prone to error.[16]
11. Evidence of incorrect and inconsistent disclosure
of theatre utilisation data by individual Trusts was found, raising
concerns about the validity of the annually published theatre
utilisation data. Inconsistency, inaccuracy, and unreliability
in published theatre utilisation data renders publication quite
pointless and comparisons useless. Theatre costing facilities
were not developed within hospitals' theatre management information
systems so that no unit cost comparisons could be made between
hospitals. It is important that the Department and the Trusts
are able to benchmark their performance against other providers,
and without timely and reliable data this will not be possible.[17]
12. We were concerned to learn of the fragmented
theatre management structures within one of the largest acute
hospitals in Northern Ireland, the Royal Victoria Hospital (RVH).
These did not facilitate the good use of its 20 theatres.[18]
Commenting, in particular, on the considerable scope for improving
the management of the theatres in Northern Ireland's Regional
Cardiac Surgery Unit at the RVH, the C&AG noted that the role
of theatre manager was not being exercised at a sufficiently senior
level and the Unit did not have a dedicated theatre users' committee.
The unit's manual information systems were found to be time consuming
and unreliable as an accurate source of information on the use
of its three theatres.[19]
13. Against this background, we asked the Department
whether it had defined and agreed with Trusts a common set of
performance measures for the use of operating theatres.[20]
We were told that the Department has implemented all the recommendations
made in the C&AG's Report for improving theatre management
and control. It has been working with Trusts to ensure that they
take all the measures that are needed. This has included the introduction
of more effective theatre user committees, and the deployment
of theatre managers vested with appropriate authority that are
now in place in every acute hospital in Northern Ireland. A new
computerised theatre management information system, to be introduced
in 2005, will facilitate improved theatre management and control,
giving a common consistent information base on which to compare
the performance of each and every Trust. The Department needs
to ensure that the existing computerised theatre management systems
developed within some hospitals are compatible with this new system,
and it is essential that consultants co-operate fully in managing
and using the new system.[21]
15 C&AG's Report, paras 2.83-2.85 Back
16
ibid, paras 2.14-2.20, 2.86, Figure 4 Back
17
ibid, paras 2.86-2.87, 4.20-4.24, 4.60-4.69 Back
18
ibid, para 2.50 Back
19
ibid, paras 2.37-2.42, 2.50 Back
20
Q 9 Back
21
Qq 4, 9, 16, 78-98, 198 Back
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