Lean processes for optimizing OR capacity utilization: prospective analysis before and after implementation of value stream mapping (VSM)

Abstract

Efficient OR capacity utilization and the optimized use of human resources allowed an additional 1820 interventions to be carried out per year without any increase in human resources. In addition, perioperative patient monitoring was increased up to 100%.

A systematic review of intraoperative process mapping in surgery

“…One study described a prospective longitudinal quasi-experimental study (13), and another study described an observational prospective design (14). All studies were of non-randomised study design; five were purely observational (with no specific improvements/interventions applied) (14-18), one was a controlled before-and-after study (19), and the remainder had before-and-after study designs without controls (7,13,(20)(21)(22)(23)(24)(25)(26)(27)(28). Table 1 lists more detailed study characteristics.…”

“…In doing so, they identified improvement areas which some studies used as the basis to formulate interventions. The major aims identified were to: identify preventable disruption sources (15); increase OT utilisation (19,20); analyse time spent for each step of a surgical procedure (17,18); increasing intraoperative efficiency (7,13,21,23,27,28); improve educational opportunities (13,14,17,18); redesign intraoperative pathways (24,25); determine limitations of surgical procedure (16); improve costing activities (25); refine surgical practices (26); and determine variance in surgical performance (29). The process mapping approach was applied across a range of surgical specialties, shown in Table 2.…”

“…Eight studies used a multidisciplinary team discussion approach to identify the steps in the intraoperative period (13,(19)(20)(21)(22)24,27,28). This was advantageous as other staff responsibilities (i.e., anaesthetists, nurses and OT technicians) in surgical care could also be included in the process map (19).…”

“…This was advantageous as other staff responsibilities (i.e., anaesthetists, nurses and OT technicians) in surgical care could also be included in the process map (19). The process steps were then evaluated by the team and suggestions for improvements were identified.…”

“…Only one study observed the intraoperative pathway in real-time to identify the steps as well as record events that disrupted the natural progression of the patient journey during the operative time (15). Few studies collected the time taken for each step-in order to generate their process maps, or include in their analyses to aid in the identification of barriers to surgical efficiency (13,15,19,22). In doing so, non-value-added time was able to be assessed.…”