A Novel Network-Based Metric of Surgical Team Consistency Opens Opportunities to Improve Hospital Performance and Care Value

Abstract

Summary The Hospital for Special Surgery is a high-volume, tertiary musculoskeletal care center that performs more than 30,000 orthopedic surgical procedures annually. Attaining this volume while prioritizing patient outcomes requires optimizing surgical workflow efficiency, which is dependent on interactions among teams. It has been conjectured that consistency among surgical teams may contribute to better clinical outcomes for patients and may improve workflow and operative efficiency. However, little research has been conducted on quantifying surgical team consistency or its effects, and it is unknown whether any measures of such consistency are associated with surgical performance. Here, the authors describe the development and implementation of a novel network-based metric to measure how often different members of orthopedic surgical teams work with one another, using data on 38 surgeons and more than 500 members of hospital staff who were involved in total joint arthroplasty procedures between 2013 and 2017. The study was conceptualized in 2016, and data were extracted and validated between 2017 and 2019. Analyses performed in the second half of 2019, controlling for patient and physician factors, found that higher team consistency scores were significantly associated with decreased time to first incision, surgery duration, and operating room turnover time for both total hip and total knee arthroplasty procedures. Team consistency scores are a measure of interactions of surgeons, anesthesiologists, nurses, and associated staff involved in the procedure, quantified as the ratio of the number of times the principal surgeon worked with the index team members compared with the number of times that surgeon worked with any other staff in the prior 90 days. The consistency score was also significantly associated with decreased total operative time in total hip arthroplasty procedures but not with any increased complications after either type of total joint arthroplasty. The authors discuss how the use of this novel metric may provide insight into hospital performance and influence quality of care delivery through maximizing value.