• M Charlesworth and J J Pandit.
• Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK.
• Br J Surg. 2020 Jan 1; 107 (2): e63-e69.

BackgroundSeveral performance metrics are commonly used by National Health Service (NHS) organizations to measure the efficiency and productivity of operating lists. These include: start time, utilization, cancellations, number of operations and gap time between operations. The authors describe reasons why these metrics are flawed, and use clinical evidence and mathematics to define a rational, balanced efficiency metric.MethodsA narrative review of literature on the efficiency and productivity of elective NHS operating lists was undertaken. The aim was to rationalize how best to define and measure the efficiency of an operating list, and describe strategies to achieve it.ResultsThere is now a wealth of literature on how optimally to measure the performance of elective surgical lists. Efficiency may be defined as the completion of all scheduled operations within the allocated time with no over- or under-runs.ConclusionAchieving efficiency requires appropriate scheduling using specific procedure mean (or median) times and their associated variance (standard deviation or interquartile range) to calculate the probability they can be completed on time. The case mix may be adjusted to yield better time management. This review outlines common misconceptions applied to managing scheduled operating theatre lists and the challenges of measuring unscheduled operations in emergency settings.© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.

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