The Effects of Case Timing and Care Team Composition on Hospital Operating Room Costs for Endovascular Procedures

A Systematic Review of Operative Team Familiarity on Metrics of Efficiency, Patient Outcomes, Cost, and Team Satisfaction

“…In nonemergent endovascular operations, cases performed during regular hours with vascular-specific nursing staff had significantly lower anesthesia, OR, postanesthesia care unit and total costs than those after hours with a general on call OR nursing team (Table 3). 28 Although cardiac cases performed by the standard day team had greater total OR material costs compared with when there was a changeover in nursing staff, neither differences in costs for familiar versus unfamiliar teams nor odds of wasting supplies differed between groups 25…”

“…In nonemergent endovascular operations, cases performed during regular hours with vascular-specific nursing staff had significantly lower anesthesia, OR, postanesthesia care unit and total costs than those after hours with a general on call OR nursing team (Table 3). 28 Although cardiac cases performed by the standard day team had greater total OR material costs compared with when there was a changeover in nursing staff, neither differences in costs for Stepaniak and colleagues employed the SAQ at 2 different time points within their prospective trial and demonstrated improvement in domains of teamwork climate and patient safety with more stable operative teams. Kurmann and colleagues designed their own questionnaire, which was also completed at early and late time points, but not fully reported.…”

“…25 However, procedure times for endovascular cases performed during regular OR hours with a specialty-specific nursing team did not differ from to those performed after hours with general nursing staff (Table 1). 28 Two studies involving routine 27 and complex 26 head and neck operations reported significant reductions of 10.7% and 8.3% after establishing dedicated scrub and circulating nurses or dedicated scrub nurses alone, respectively. Finally, 1 prospective study found a 16% reduction in procedure time for simple cases but not laparoscopic ones suggesting that teaming effects may be more prominent for some procedures than others, potentially depending on procedure complexity.…”

“…There was substantial variation in which roles or combinations authors included in the operative team across studies (Supplemental Table 3, Supplemental Digital Content 1, http:// links.lww.com/SLA/D891). Three studies considered the surgical team to be the attending surgeon, surgical trainee, scrub nurse, circulating nurse, and anesthesia staff (attending or nurse anesthetist), 14,15,28 whereas 4 considered only the attending surgeon, scrub nurse, and circulating nurse. 19,20,25,27 Two studies considered only the attending surgeon-scrub nurse dynamic.…”

“…17,26 Additional variation was observed in qualifying and quantifying team familiarity among studies. Retrospective studies generally stratified teams by familiarity in 1 of 4 ways: (1) teams were designated as familiar if the case start time was during regular nursing day shift hours, as opposed to being "after hours," and/or during the surgeon's typical block time; 25,28 (2) using the number of prior collaborations as a proxy for familiarity between individuals; 17,18,[21][22][23][24] (3) by frequency with which OR staff performed cases in a given specialty 20 or collaborated with a given surgeon; 19 or (4) by taking advantage of previously existing team pairings as a part of rotations or service structure (Supplemental Table 3, Supplemental Digital Content 1, http://links.lww.com/SLA/D891). 16,26 Stratification by number of prior collaborations was most commonly employed for analyses of downstream effects due to increasing familiarity between surgeon-surgeon pairs.…”