What delays your case start? Exploring operating room inefficiencies

Abstract

Introduction Improving operating room (OR) inefficiencies benefits the OR team, hospital, and patients alike but the available literature is limited. Our goal was, using a novel surgical application, to identify any OR incidents that cause delays from the time the patient enters the OR till procedure start (preparatory phase). Materials and methodsWe conducted an IRB approved, prospective, observational study between July 2018 and January 2019. Using a novel surgical application (ExplORer Surgical) three observers recorded disrupting incidents and their duration during the preparatory phase of a variety of general surgery cases. Specifically, the number and duration of anesthesia delays, unnecessary/distracting conversations, missing items, and other delays were recorded from the moment they started until they stopped affecting the normal workflow. Results Ninety-six OR cases were assessed. 20 incidents occurred in 18 (19%) of those cases. The average preparatory duration for all the cases was 20.7 ± 8.6 min. Cases without incidents lasted 19.5 ± 7.4 min while cases with incidents lasted 25.9 ± 11.2 min, p = 0.03. The average incident lasted 3.7 min, approximately 18% of the preparatory phase duration. Conclusion The use of the ExplORer Surgical app allowed us to accurately record the incidents happening during the preparatory phase of various general surgery operations. Such incidents significantly prolonged the preparatory duration. The identification of those inefficiencies is the first step to targeted interventions that may eventually optimize the efficiency of preoperative preparation.

Assessing the Precision of Surgery Duration Estimation: A Retrospective Study

“…However, testing other features such as BMI and ASA might reveal other correlations, as they were found to significantly affect surgery duration. 25 , 30 , 39 , 43 , 49 …”

Efficiency in the operating room: optimizing patient throughput

“…In addition to maintaining OR efficiency, delays can lead to increased costs, decreased utilization, and decreased patient and staff satisfaction. [19][20][21][22][23] Although entering the operating room with a patient on time seems simple, the process requires the coordination of personnel and processes throughout the entire perioperative enterprise. Often, the failure of any one part of the throughput process has a domino effect and causes delays.…”

“…Starting the operative day on time is important for many reasons. In addition to maintaining OR efficiency, delays can lead to increased costs, decreased utilization, and decreased patient and staff satisfaction 19–23. Although entering the operating room with a patient on time seems simple, the process requires the coordination of personnel and processes throughout the entire perioperative enterprise.…”

Utilization Fraction of Reduction Mammoplasty Instrument Sets

“…One reason for this is that systematic inefficiencies in the provision of surgical care can quickly balloon into significant, unnecessary costs. There has been an uptick in quality improvement projects examining inefficiencies in surgery, with some focusing on reducing costs associated with the operating room 2–5 . Effective use of reusable surgical supplies is a target area for improvement that could benefit patient care while reducing costs 6 …”

“…There has been an uptick in quality improvement projects examining inefficiencies in surgery, with some focusing on reducing costs associated with the operating room. [2][3][4][5] Effective use of reusable surgical supplies is a target area for improvement that could benefit patient care while reducing costs. 6 Lean methodologies, designed to improve quality and safety in the manufacturing sector, have been applied to healthcare systems to address rising costs and concerns.…”