Operating-Room Throughput: Strategies for Improvement

Saleh, Khaled J.; Novicoff, Wendy M.; Rion, David; MacCracken, Linda; Siegrist, Richard B.

doi:10.2106/jbjs.h.01530

Cited by 23 publications

(12 citation statements)

References 36 publications

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“…9 By breaking down the delivery of this service in a stepwise fashion, we were able to identify predictive measures to allow the successful completion of 4 primary joint replacements in a standard 8-hour OR day. These benchmarks can facilitate targeted group interventions to improve efficiency and provide direct feedback in regards to individual performances.…”

Section: Resultsmentioning

confidence: 99%

“…Although several groups have looked at OR inefficiencies, such as turnaround time and dedicated teams, 6,7 there is still a lack of established benchmarks to successfully maximize OR efficiency without increasing resources. 8,9 In 2004, a 4-joint OR initiative was instituted within our hospital to minimize wait times for joint replacements by improving overall throughput while minimizing the need to increase the number of OR days to perform joint replacement surgery. As part of this initiative, team leaders, customized joint instrument trays and patient selection parameters (i.e., body mass index [BMI] < 35, American Society of Anaesthesiologists [ASA] score of 2 or less, no prior joint surgery) were established.…”

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Working toward benchmarks in orthopedic OR efficiency for joint replacement surgery in an academic centre

Beaulé

Frombach

Ryu

2015

cjs

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Background:The introduction of 4-joint operating rooms (ORs) to meet provincial wait time targets represented a major change in practice, providing an opportunity to optimize patient care within an OR time allotment of 8 hours. We reviewed our success rate completing 4 joint replacements within 8 hours and defined benchmarks for successful completion. Methods:We reviewed the surgeries performed in the 4-joint ORs between May and October 2012. Using prospectively collected data from the Surgical Information Management System, each surgery time was divided into the following components: anesthesia preparation time (APT), surgical preparation time (SPT), procedure duration, anesthesia finishing time (AFT) and turnover time. We defined success as 4 joint replacements being completed within the allotted time. Results:We reviewed 49 4-joint OR days for a total of 196 joint surgeries. Of the 49 days, 24 (49%) were successful. Only 2 surgeons had a success rate greater than 50%. Significant predictors of success were APT (odds ratio 1.09, 95% confidence interval [CI] 1.02-1.16), procedure duration (odds ratio 1.02, 95% CI 1.00-1.05) and AFT (odds ratio 1.19, 95% CI 1.06-1.34). We calculated probabilities for each component and derived benchmark times corresponding to the probability of 0.60. These benchmarks were APT of 9 min, SPT of 14 min, procedure duration of 68 min, AFT of 4 min and turnover of 15 min. Conclusion:We established benchmark times for the successful completion of 4 primary joint replacements within an 8-hour shift. Targeted interventions could maximize OR efficiency and enhance multidisciplinary care delivery.Contexte : Afin d'atteindre les cibles provinciales en matière de temps d'attente, on a mis en service des blocs opératoires (BO) dédiés à la réalisation de 4 arthroplasties consécutives. Cette mesure a représenté un changement de pratique majeur et a offert une occasion d'optimiser les soins aux patients à l'intérieur du temps opératoire alloué, soit 8 heures. Nous avons examiné notre taux de succès à effectuer 4 arthroplasties en 8 heures et défini les critères de réussite.Méthodes : Nous avons passé en revue les chirurgies effectuées dans les BO dédiés entre mai et octobre 2012. À l'aide des données prospectives fournies par le système de gestion des données chirurgicales, la durée de chaque intervention a été divisée en 5 temps : temps de préparation de l'anesthésie (TPA), temps de préparation chirurgicale (TPC), durée de l'intervention, temps de finalisation de l'anesthésie (TFA) et temps de roulement. La réussite était définie comme la réalisation complète de 4 arthroplasties à l'intérieur des temps alloués.Résultats : Nous avons analysé 49 jours de BO dédiés, totalisant 196 chirurgies articulaires. Sur les 49 jours, 24 (49 %) ont été couronnés de succès. Seulement 2 chirurgiens ont obtenu un taux de réussite supérieur à 50 %. Les principaux prédicteurs de succès étaient le TPA (rapport des cotes 1,09, intervalle de confiance [IC] de 95 % 1,02-1,16), la durée de l'intervention (rapport des c...

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Working toward benchmarks in orthopedic OR efficiency for joint replacement surgery in an academic centre

Beaulé

Frombach

Ryu

2015

cjs

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“…Our study design allowed only analysis of the operating time; however, by ruling out a substantial difference between sectors, it suggests that efforts to improve efficiency in the public sector should focus on other areas of theatre time. [9][10][11][12][13] Cullen et al compared standard public health cost effectiveness against a financially incentivized model within the public sector. 8 Improvements in utilization time may be achieved through scheduling strategies, predetermined first cases, patient checklists, theatre flow coordinators and financial incentivisation.…”

Section: Discussionmentioning

confidence: 99%

Operating time for total knee arthroplasty in public versus private sectors: where does the efficiency lie?

Cowley

Frampton

Young

2018

ANZ Journal of Surgery

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Background: Efforts to improve theatre efficiency aim to reduce health costs and maximize productivity. Operating lists in the private sector typically contain more cases than the public sector but it is unclear if this is a result of shorter operative times or reduced times between cases. We aimed to answer the question: Are operating times from skin incision to skin closure shorter in private compared to the public sector for total knee arthroplasty (TKA)? Method: The New Zealand Joint Registry was used to compare operating times for primary TKA performed for a diagnosis of osteoarthritis between the public and private sectors. Surgeries included were completed by surgeons who had performed more than 50 TKAs in both sectors. Multivariate analysis was used to control for other variables which may influence operative duration. Results: After adjustment for the variables of patient sex, age, American Society of Anesthesiologists score, body mass index and surgeon effect, a 3-min difference was present between the public and private sectors (public mean: 79.9 min versus private mean: 76.4 min (P < 0.05)).Conclusions: This study found minimal difference in operating time for TKA between the public and private sectors suggesting differences in overall theatre efficiency between the two sectors are not due to a shorter operative duration.

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“…15 Phys ician assistants can improve orthopedic surgical care in the OR for patients by attending to patient positioning, draping and wound closure. 16 In this study, the PA in the double room experiment helped to maximize the surgeon's capacity.…”

Section: Operating Roommentioning

confidence: 99%

Utilizing the physician assistant role: case study in an upper-extremity orthopedic surgical program

Hepp

Suter

Nagy

et al. 2017

CJS

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Background: Shortages with resources and inefficiencies with orthopedic services in Canada create opportunities for alternative staffing models and ways to use existing resources. Physician assistants (PAs) are a common provider used in specialty orthopedic services in the United States; however, Canada has limited experience with PAs. As part of a larger demonstration project, Alberta Health Services (AHS) implemented 1 PA position in an upper-extremity surgical program in Alberta, Canada, to demonstrate the role in 4 areas: preoperative, operative, postoperative and follow-up care. Methods:A mixed-methods evaluation was conducted using semi-structured interviews (n = 38), health care provider (n = 28) and patient surveys (n = 47), and 2 years of clinic data on new patients. Data from a double operating room experiment detailed expected versus actual times for 3 phases of surgery (pre, during, post).Results: Preoperatively, the PA prioritizes patient referrals for surgery and redirects patients to alternative care. In the second year with the PA in place, there was an increase in total new patients seen (113%). Postoperatively, the PA attended rounds on 5 surgeons' patients and handled follow-up care activities. Health care providers and patients reported that the PA provided excellent care. Findings from the operating room showed that the preparation time was greater than expected (38.6%), whereas the surgeon time (20.6%) and postsurgery time (37.2%) was less than expected. Conclusion:After 24 months the PA has become a valuable member of the health care team and works across the continuum of orthopedic care. The PA delivers quality care and improves system efficiencies.Contexte : Le manque de ressources et les inefficacités des services d'orthopédie au Canada créent des possibilités pour de nouveaux modèles de dotation et de mise à contribution des ressources existantes. Aux États-Unis, les adjoints au médecin sont des fournisseurs de soins courants dans les services spécialisés d'orthopédie comparativement au Canada qui en fait une utilisation limitée. Dans le cadre d'un grand projet de démonstration, Alberta Health Services (AHS) a créé un poste d'adjoint au méde-cin dans un programme de chirurgie des membres supérieurs en Alberta, au Canada, afin de démontrer le rôle de l'adjoint au médecin à 4 étapes des soins : préopératoire, opératoire, postopératoire et suivi. Méthodes :Une évaluation avec méthodes mixtes a été effectuée au moyen d'entrevues semi-structurées (n = 38), de sondages auprès de fournisseurs de soins (n = 28) et de patients (n = 47), et de données des nouveaux patients de la clinique sur 2 ans. Les données d'une expérience en salle d'opération double indiquaient le temps prévu et le temps réel de 3 étapes des chirurgies (pré, per et postopératoire).Résultats : À l'étape préopératoire, l'adjoint au médecin a établi la priorité des patients référés en chirurgie et redirigé les patients vers d'autres soins. Lors de la deuxième année de l'adjoint au médecin, nous avons observé une augmentation d...

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Operating-Room Throughput: Strategies for Improvement

Cited by 23 publications

References 36 publications

Working toward benchmarks in orthopedic OR efficiency for joint replacement surgery in an academic centre

Working toward benchmarks in orthopedic OR efficiency for joint replacement surgery in an academic centre

Operating time for total knee arthroplasty in public versus private sectors: where does the efficiency lie?

Utilizing the physician assistant role: case study in an upper-extremity orthopedic surgical program

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