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Operating Theatre Efficiency

The Operating Theatre Efficiency program aims to develop strategies for hospitals to improve theatre efficiency in NSW. These strategies will include the recommendations in Auditor General’s Report on Operating Theatre Efficiency.

The program will focus on three key areas:

The ACI and the Ministry of Health have established three working groups for each of the identified priority areas to progress the outcomes and discussions from the September Surgery Efficiency workshop. The three working groups are overseen by an Operating Theatre Efficiencies Steering Committee and the ACI Surgical Services Taskforce.

Efficient Operating Theatres on a Budget forum

Friday 30 October, 2015

Efficiency measures

Operating Theatre Efficiency Guidelines

The Operating Theatre Efficiency Guidelines have been developed as a best practice guide for the management and governance of OTs in NSW public hospitals and are intended to provide assistance  to OT committees, managers and staff in the management of efficient operating theatres at hospital and Local Health District (LHD) levels.

The Guidelines provide information on OT efficiency measures, management processes and cost considerations based on expert recommendations.

Efficiency Measures Working Group

The Efficiency Measures Working Group provides advice on operating theatre measures and KPIs that reflect efficiency and on process and responsibilities for data collection.

Considerations for the working group include data definitions, data quality, processes for data collection and data interpretation and analysis.

First case on time theatre starts

The First case on time theatre starts project aims to improve operating theatre efficiency by ensuring that patients receive timely and quality care at the appropriate time.

In order to assist in identifying the challenges involved in achieving the target, a short survey was developed to provide information about current work processes, including the steps preceding the patient’s admission. View the survey results (pdf - 65 KB).

The information received from the survey has assisted in the development of a 'first case on time starts' checklist.

Successful implementation of the Operating Theatre Efficiency Guidelines requires a collaborative multidisciplinary OT team approach.

To further assist sites to identify opportunities for improvement the ACI has developed an Operating Theatre Self-Assessment.

The tool is aligned to the efficiency guidelines and allows managers and clinicians to quickly identify areas to focus on for further investigation through the use of drop down questions and a dashboard.

Theatre costing

Operating Theatre Standard Cost Template

The OT Standard Cost Template has been developed to improve the collection and allocation of OT costing data.

The template calculates an average cost per minute/session for a standard OT to facilitate modelling of OT costs for various scenarios.

Theatre Costing Working Group

The Theatre Costing Working Group provides advice on costs associated with the different elements of surgery, feasible costing measurements and measuring capital cost depreciation in operating theatres.

The average cost of a fully staffed operating theatre per hour of surgery in NSW has never been accurately defined. Accurate cost estimates should consider all elements of surgery such as staffing, consumables, wastage in the operating theatre and capital cost deprecation.

This group aims to provide an indication of the average cost of surgery in NSW to allow sites to monitor variance in their costs, and identify areas for efficiency.

Whole of Surgery

Whole of Surgery Working Group

The Whole of Surgery Working Group provides advice on the responsibilities of managers within the operating theatre, effective structures for collaboration between management and clinical staff, and developing effective frameworks that promote efficiency in patient throughput and quality care.

There is a need for the operating theatre efficiency guidelines to provide direction on processes that can be employed by leadership, managers and operating theatre staff to enhance efficiency.

Considerations for the working group include management/leadership, models of care, staffing, and theatre size.


The Agency for Clinical Innovation (ACI) and the Ministry of Health hosted the Operating Theatre Efficiency workshop on Friday 20 September 2013.

Entitled, Time in, Time out, Time over! A fresh look at operating theatres!, this workshop was designed for surgeons, operating theatre managers, senior surgical clinical staff, and senior managers responsible for the performance of operating theatres.



Surgical Services Taskforces Manager
Agency for Clinical Innovation
Phone: 02 9464 4644