Main Theme: Innovation
Introduction:
Efficient theatre utilisation is increasingly important in addressing growing paediatric ENT waiting lists. In 2014, our department described a novel 'One on, One off' theatre model, utilising two anaesthetists, two operating department practitioners and an ENT surgeon to maximise theatre efficiency. Twelve years later, we evaluated whether this model continues to deliver efficient, high-volume paediatric day-case surgery within the NHS.
Methods:
A retrospective evaluation was undertaken of morning paediatric ENT theatre sessions between January and July 2026. Data collected included planned and completed procedures, theatre utilisation and cancellations. Procedures included tonsillectomy, adenoidectomy, grommets and other paediatric ENT day-cases.
Results:
Fourteen consecutive theatre lists were analysed. Ninety-three procedures were scheduled, of which 85 (91.4%) were completed, averaging 6.1 procedures per session. Mean theatre utilisation was 80.4%. Most cancellations resulted from patient-related factors, including illness, patient choice and changes in clinical management, rather than limitations of the theatre pathway. Despite these unavoidable cancellations, the alternating anaesthetic model maintained continuous theatre flow, with only one list overrunning, attributable to the addition of non-ENT procedures rather than inefficiencies within the operating pathway.
Conclusions:
Twelve years after its original publication, the 'One on, One off' theatre model remains a sustainable and efficient approach to delivering high-volume paediatric ENT day-case surgery. Despite increasing NHS service pressures, this simple workflow continues to optimise theatre productivity while maintaining flexibility to accommodate unavoidable patient-related cancellations. This reproducible model offers a practical solution for paediatric ENT units seeking to improve theatre efficiency and maximise operative capacity
References
DT Walker, S Cartwright, PDR Spraggs, and JD Spraggs. ‘One on, one off’ as a model for safe and efficient paediatric ENT surgery. Ann R Coll Surg Engl (Suppl) 2014; 96: 153–155