VNJ Volume 40 (1) February 2025 | Page 58

Kay Eminson , BSc ( Hons ), RVN , Cert VNEV Winner of Best Presentation 2024

Introduction

A quality improvement audit was designed to help assess surgery length in the referral department , to streamline the running and scheduling of procedures . It had been found that the veterinary surgeon ( VS ) was overbooked or running late for evening consultations and the practice needed to assess why .

The impact of incorrectly estimating surgical time is reported in the human medical literature , and is shown to have a negative impact on the hospital , staff and patients . Overbooking can add pressure and stress to the VS and their team , and can impact on patient safety .

Ryan et al . [ 1 ] found that 25 % of human surgical cases were correctly estimated . Based on this study , it was hypothesised that the VS would correctly estimate 30 % of cases .

Materials and methods

Using 50 randomly selected referral surgery cases , the predicted and actual surgical times were audited . Data were collected from the anaesthetic sheet on the Smartflow ( Idexx UK ) system and actual surgical time recorded by the veterinary nurse ( VN ). The predicted time given by the VS was taken from the preoperative checklist found on Smartflow . The results from the first audit were made available to the VS . A second audit of a further 50 cases was performed 7 months later using the same method . The patients were a range of ages and species , and were undergoing various types of procedures . All of the cases audited had the same VS but had a different combination of VNs . A case was classed as being correctly estimated if its actual surgical time was at or below the time estimated .

Results

The audit results from 2023 found that the average predicted time was underestimated by 29 minutes , and the VS correctly estimated 52 % of cases . The second audit found that the average predicted time was underestimated by 19 minutes , and the VS correctly estimated 70 % of cases .

Conclusions

The ability to estimate surgical time is not consistent with the findings in the human medical literature , in which 25 % of cases were correctly estimated . On average , this VS was correct in 61 % of cases , therefore disproving the hypothesis .

There is limited literature on this topic and further investigation into this issue would be beneficial . Frapwell et al . [ 2 ] audited a VS ' s ability to estimate length and found a mean error of 33.3 %, which is marginally in line with the results of this study .

The predictions are estimates only of surgical time . A series of inefficiencies may increase overall anaesthetic time , possibly affecting the daily scheduling of procedures and increasing risk for the patients . Further research and discussion with the team is needed on whether forms should be edited to help plan for longer anaesthetic times and not just the actual surgical time .

This study has highlighted the need to increase the data collected and to consider the categories of cases , to prevent bias .

These data can be carried forward within the veterinary profession to better understand the need for correct planning and communication and the effects of delayed starts or inefficiencies , and how these can affect the team and the patients .

REFERENCES

1 Ryan D , Rocks M , Noh K , Hacquebord H , Hacquebord J . Specific factors affecting operating room efficiency : an analysis of case time estimates . Journal of Hand Surgery . 2023 ; 49 ( 5 ): 492 . e1 – 492 . e9 . Available from : https :// doi . org / 10.1016 / j . jhsa . 2022.08.025 .

2 Frapwell E , Filipas MC , Alexander A . Assessing veterinary professionals ' ability to estimate length . Veterinary Record . 2023 ; 192 ( 6 ): e2480 . Available from : https :// doi . org / 10.1002 / vetr . 2480 .

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