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The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study is to assess for feasibility of a district hospital providing care in accordance to the recommendations.

A total of 100 consecutive patient unscheduled episodes of care were prospectively included. Information regarding demographics, timeliness of investigations, operations, consultant input and clinical outcomes was collated. All patients were risk-adjusted for mortality. The data were compared to the guidelines.

A total of 91 patients were included; 80 patients underwent surgery. There were 18 deaths (22.5 per cent), eight (10 per cent) post-operative within 30 days. There was no statistical difference between deaths and day of admission or surgery. There were 39 critically-ill patients, none were reviewed by a consultant within the recommended 30 minutes. Of the critically-ill patients, 23 underwent CT scanning, none within the recommended 30 minutes. All patients were operated within the recommended timeframe by urgency grading. For those predicted mortality rate >5 per cent, a consultant was present in theatre for 97 per cent of cases. All patients had a consultant review within 24 hours of admission.

To the authors' knowledge this is the first evaluation of the practical difficulties in achieving consultant delivered care in surgery in a district general hospital. These results are interesting to clinicians and service planners involved in developing emergency services. Adhering to these guidelines would require significant re-allocation of resources in most hospitals and may require centralisation of services.

The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014.

The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30, 2014. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated surgeons’ efficiency scores using data envelopment analysis.

The efficiency scores of each surgical specialty were significantly different (p=0.000).

This result demonstrates that the Japanese surgical reimbursement scales still fail to reflect resource utilization despite the revision of surgical fee schedule.

NCEPOD states that all emergency patients must have prompt access to theatres, critical care facilities, and appropriately trained staff 24 hours/day, every day of the year. The purpose of this paper is to determine waiting time for plastic surgery trauma patients and the financial implications to the NHS.

The approach was a prospective audit of emergency surgery (Lister Hospital, Stevenage) from July 2005‐January 2006. Delay times were calculated from booking time to time of operation. These were assessed on a standard of a day surgery unit, where the ideal maximum is a half day wait. Financial implications were calculated. The number of UK units without a dedicated list is highlighted.

A total of 615 operations were booked, 60 per cent of which were assessed as suitable for a DSU set up. With an ideal standard of half a day's wait, an average 22 per cent of patients achieved this, with 64 per cent of patients waiting one excess day. On average patients waited an excess of 1.3 days. An average of 24 excess bed days/week (bed cost £300/day) were used waiting for surgery. This equates to 1,400 bed days (£400,000/annum).

The paper shows how it is possible that 1,000 bed days/annum (£300,000) could be saved by a DSU type setup. With 61 plastic surgery units in the UK, 40 per cent reported no dedicated trauma list (93 per cent response rate). This is a potential saving of £8,400,000 per annum. From this audit a half day dedicated DSU list was created, and a re‐auditing process will occur.

The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016.

The authors collected data from surgical records in the Teikyo University electronic medical record system from April 1 till September 30, 2016. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated each surgeon’s efficiency score using output-oriented Charnes–Cooper–Rhodes model of data envelopment analysis. The authors compared the efficiency scores of each surgical specialty using the Kruskal–Wallis and the Steel method.

The authors analyzed 2,558 surgical procedures performed by 109 surgeons. The difference in efficiency scores was significant (p = 0.000). The efficiency score of neurosurgery was significantly greater than obstetrics and gynecology, general surgery, orthopedics, emergency surgery, urology, otolaryngology and plastic surgery (p<0.05).

The authors demonstrated that the surgeons’ efficiency was significantly different among their specialties. This suggests that the Japanese surgical reimbursement scales fail to reflect resource utilization despite the revision in 2016.

NCEPOD (1990) states that we must ensure that all emergency patients have prompt access to theatres, critical care facilities, and appropriately trained staff 24 hours/day, every day of the year. Hospitals providing emergency services must provide a dedicated emergency theatre. Our previous study highlighted potential savings and reduced waiting times, leading to the introduction of a dedicated weekly half‐day list. This purpose of this study was to evaluate the effect of the extra list on both waiting times and spending.

This research is based on a prospective audit of emergency surgery (Lister Hospital, Stevenage) from October‐December 2006. Delay times from booking time to time of operation were calculated. This was assessed based on a standard of a day surgery unit, where the ideal maximum is a half‐day wait. Findings were compared with data prior to the introduction of a dedicated list.

There were 186 operations performed. The mean wait for surgery was 0.7 days/patient, compared with 1.3 days/patient prior to the dedicated list. Assuming that the ideal waiting time is a maximum of half a day, 55 per cent of patients achieved this, compared with 22 per cent prior to the introduction of the list.

The introduction of a dedicated day surgery plastic surgery trauma list led to a significant reduction in patient wait time. The dedicated list also achieved a potential reduction of 900‐bed days/annum, thus saving £180,000/annum for the trust.

Two prospective synchronous regional audits involving three tertiary plastic surgery units in mixed service hospitals were carried out to study delays in the management of emergency patients and their possible causes. Each audit was over a one‐month period. These prospective studies investigated “fasting times” (the length of time that an individual patient was fasted prior to definitive management) and “injury to theatre time” (the time span from the time of injury to the time of surgery for patients going to the operating theatre). Results are analysed and discussed and recommendations for improvement are offered.

Gallstone‐related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone‐disease is by laparoscopic cholecystectomy, which can be safely and cost‐effectively performed during a short hospital stay or as day‐case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings.

The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment.

Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co‐morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least £16,194.

A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.

The purpose of this study is to create a knowledge base for decision-making in healthcare design by seeking, analyzing and discussing the preferences of facility managers of healthcare facilities regarding floor finishes and their selection criteria. The goal is to enable a simplified and holistic selection of floor finishes based on multiple criteria. The authors studied floor finish selection in three healthcare units: emergency, surgery and in-patient units.

The authors completed a literature review to identify types of floor finishes currently used in healthcare facilities and the criteria applied for their selection. Using the literature survey results, a questionnaire was designed and administered to healthcare facility managers. The descriptive statistical analysis and the Friedman and Wilcoxon signed-ranks tests were used for reporting and analyzing the survey data.

The top five floor finishes used in the healthcare sector were identified as vinyl flooring, vinyl composite tile (VCT), rubber, linoleum and ceramic flooring. The top five selection criteria for floor finishes were durability, infection control, ease of maintenance, maintenance cost and user safety. The non-parametric test results show that the floor finish rankings and selection criteria were similar in the three healthcare units under study.

The most significant contribution of this research is to the design decision-making process of healthcare facilities. These results offer an understanding of what floor finishes are preferred by healthcare facility managers and why. This knowledge is crucial for designers and facility managers to make informed choices and floor finish manufacturers to keep their product line relevant to the industry.

The high variability in cardiac surgery length – is one of the main challenges for staff managing productivity. This study aims to evaluate the impact of six interventions on open‐heart surgery operating theatre productivity.

A discrete operating theatre event simulation model with empirical operation time input data from 2,603 patients is used to evaluate the effect that these process interventions have on the surgery output and overtime work. A linear regression model was used to get operation time forecasts for surgery scheduling while it also could be used to explain operation time.

A forecasting model based on the linear regression of variables available before the surgery explains 46 per cent operating time variance. The main factors influencing operation length were type of operation, redoing the operation and the head surgeon. Reduction of changeover time between surgeries by inducing anaesthesia outside an operating theatre and by reducing slack time at the end of day after a second surgery have the strongest effects on surgery output and productivity. A more accurate operation time forecast did not have any effect on output, although improved operation time forecast did decrease overtime work.

A reduction in the operation time itself is not studied in this article. However, the forecasting model can also be applied to discover which factors are most significant in explaining variation in the length of open‐heart surgery.

The challenge in scheduling two open‐heart surgeries in one day can be partly resolved by increasing the length of the day, decreasing the time between two surgeries or by improving patient scheduling procedures so that two short surgeries can be paired.

A linear regression model is created in the paper to increase the accuracy of operation time forecasting and to identify factors that have the most influence on operation time. A simulation model is used to analyse the impact of improved surgical length forecasting and five selected process interventions on productivity in cardiac surgery.

The purpose of this paper is to promote a business process approach for developing and improving the efficiency of hospital service quality in order to reduce clinical risks and increase patients satisfaction. The problems healthcare facilities face are how to reduce waste and risk and improve quality. The adoption of a process-focused organization could reduce organizational errors which have a negative influence on performance.

The research is based on a case study methodology, analyzing a specific real-life case. It is shown a practical example in the surgery department of an Italian hospital, identifying, analyzing and managing critical situations, in terms of improvement. To this end, national and international contributions, public documents, institutional websites, conference papers, books, workshops and hospital websites have been analyzed. Moreover, other data were collected through questionnaires.

Results show how a comprehensive view of the processes may lead to improvement in operations by identifying different risks and bottlenecks, suggesting the rapid implementation of corrective policies and improvements, in terms of overall efficiency.

By implementing innovative organizational processes to identify and reduce bottleneck a healthcare system could achieve a competitive advantage.

Within the Italian healthcare system, limited attention has been paid to the design of healthcare facilities. Flexible solutions are necessary for lean management. The originality of this work lies in the analysis applied to a complex organization, through which hidden critical situations have been identified, and solutions to improve and provide better healthcare management have been suggested.