101Smart Ltd.

Improving Cataract Surgery Theatre throughput by 60%: The Nottingham Faster Turnover Cataract Pathway

Aidrian Kwa

Adrian Kwa, Ana Magalhaes, Debra Duke
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom


Up until 2022, Nottingham has lagged behind our peers in cataract surgery performance, managing on average 5 cataract surgery per session. GIRFT Ophthalmology has set a target of 8 mixed-complexity cataract surgery per 4 hours session. We set out to find a way to improve our theatre throughput.

We performed a time-motion study of our theatre workflow. We define "Turnover Time" as the time between the last dressing being applied to the last patient, to the end of "Time Out" of WHO Surgical checklist for the next patient. Our turnaround time was 20 minutes per case, and was the rate limiting factor in our pathway.

Our theatre suites, like many others across the country, do not have dedicated surgical prep rooms to allow laying up of surgical trays in advance. Using the anaesthetic room as pop-up surgical preparation room, and a portable laminar flow machine to create a sterile field, we laid up our surgical trays while a case is still on table. Theatre turnover time reduced to around 6 minutes. Staff and patients' satisfaction remains high and patients' care is not compromised.

We are now able to complete 8 medium-complexity cataract surgery in around 3 hours. We aim to further increase our throughput, with 10 cases per session as an achievable target in the near future. We have had success with other types of ophthalmic surgeries, and our innovative pathway can be applied to other types of high turnover surgical cases under local anaesthetics in other specialties.