Better management of hospitals could see an extra 20,000 operations each year Inefficiencies in hospital management are costing up to 20,000 patients a year the opportunity to have their surgery. NSW hospitals could perform an extra 20,000 operations a year if they were better managed, according to the State's Auditor-General. A "tune up" of the public hospital system is needed to ensure the annual $1.3 billion budget for surgery is maximised, said Peter Achterstraat. Examining inefficiencies across 270 public hospital operating theatres the audit found less than half of all scheduled first operations of the day start on time. In addition, surgeries in some hospitals were being cancelled on the day at a rate of 1 in 10. About 210,000 elective surgeries were carried out last year but the Auditor general said more could be achieved with the existing resources and funding if NSW Health met its own existing targets. "Hospitals just need to start the first operations of the day on time, stay on time and reduce the number of cancellations," Mr Achterstraat said. In some hospitals less than 10 per cent of first operations start on time yet in other hospitals over 95 per cent start on time. Some of the best performing hospitals for meeting schedules include Temora (100 per cent); Ryde (97 per cent) Fairfield (96 per cent), Liverpool (89 per cent) and Bankstown (84 per cent). Those who recorded low on time rates include Kurri Kurri (4 per cent); Sutherland (8 per cent); Wollongong (18 per cent) and John Hunter (22 per cent). Mr Achterstraat said delays in start time included someone being late; medical equipment not being ready or test results not available. The rate of cancellations was "50-50" due to problems with surgeon availability or the patient - citing cases were patients failed to turn up or forgot to fast. Determining who in charge of the operating theatre was another problem identified in the audit which reported "theatre managers" have limited authority and influence. "In the past matrons often used to rule with iron fist and things used to get done and its seems now there's more uncertainty around who's actually in charge of the operating theatre," Mr Archterstraat said. If that can be clarified there might be opportunities to have more operations start on time. The report also recommended NSW Health investigate significant discrepancies in the cost of some elective surgeries with the cost of a knee replacements $13,177 in some hospitals compared with $22,638 in others. Health Minister Jillian Skinner welcomed the report and acknowledged the need for greater improvement. She said a taskforce was already developing guidelines to impevoe efficiencies in operating theatres and has asked NSW Health Director General "to consider and implements all recommendations made by the Auditor-General."