Operating Room Turnover Research Articles

Surgeon factors and their association with operating room turnover time.

Surgeon factors and their association with operating room turnover time.

Influence of a surgeon's exposure to operating room turnover delays on patient outcomes.

A surgeon's daily performance may be affected by operating room organizational factors, potentially impacting patient outcomes. The aim of this study was to investigate the link between a surgeon's exposure to delays in starting scheduled operations and patient outcomes. A prospective observational study was conducted from 1 November 2020 to 31 December 2021, across 14 surgical departments in four university hospitals, covering various surgical disciplines. All elective surgeries by 45 attending surgeons were analysed, assessing delays in starting operations and inter-procedural wait times exceeding 1 or 2 h. The primary outcome was major adverse events within 30 days post-surgery. Mixed-effect logistic regression accounted for operation clustering within surgeons, estimating adjusted relative risks and outcome rate differences using marginal standardization. Among 8844 elective operations, 4.0% started more than 1 h late, associated with an increased rate of adverse events (21.6% versus 14.4%, P = 0.039). Waiting time surpassing 1 h between procedures occurred in 71.4% of operations and was also associated with a higher frequency of adverse events (13.9% versus 5.3%, P < 0.001). After adjustment, delayed operations were associated with an elevated risk of major adverse events (adjusted relative risk 1.37 (95% c.i. 1.06 to 1.85)). The standardized rate of major adverse events was 12.1%, compared with 8.9% (absolute difference of 3.3% (95% c.i. 0.6% to 5.6%)), when a surgeon experienced a delay in operating room scheduling or waiting time between two procedures exceeding 1 h, as opposed to not experiencing such delays. A surgeon's exposure to delay before starting elective procedures was associated with an increased occurrence of major adverse events. Optimizing operating room turnover to prevent delayed operations and waiting time is critical for patient safety.

HoLEP Learning Curve-Resident Perspective: Survey of Senior Residents from High-Volume Tertiary Center.

Objective: We aim to report the learning curve and experience performing holmium laser enucleation of the prostate (HoLEP) from a resident standpoint trained at a tertiary high-volume center. Methods: An electronic survey was distributed to 10 surveyees that included recently graduated chief residents trained at Indiana University in the past 3 years i.e., between 2020 and 2022 with a 100% response rate. The questionnaire focused on HoLEP training experience based on a recently established mentorship curriculum in training the residents through each individual step of the surgery. Results: The average learning curve for performing HoLEP was reported to be greater than 25 cases with 50% of the residents reporting >50 cases to master the technique. The surgical difficulty of steps of the HoLEP were rated on a subjective scale of 1-5: 1 = very easy, 2 = easy, 3 = neutral, 4 = hard, and 5 = very hard. The common challenging steps in decreasing the order of difficulty as reported are performing apical enucleation, joining anterior and posterior planes, and dividing anterior commissure with a mean rating of 3.5, 3.1, and 3.1, respectively. The most difficult aspect of the surgery to master was performing apical dissection (60%). Comparing operative parameters for HoLEP with transurethral resection of the prostate in aspects of resection volume and times, 70% of candidates reported it better for HoLEP whereas 20% had similar times for both procedures. A total of 90% of the residents felt confident to offer HoLEP as part of their practice without the need for any further training. Regarding the initial challenge of including HoLEP surgery in practice, the majority (60%) reported difficulty with equipment set up in their practice while 20% reported difficulty maintaining efficient operating room (OR) times and turnover. Conclusion: We believe HoLEP can be performed immediately after residency training and incorporated into practice with high volume, repeated exposure to HoLEP surgery throughout residency based on study results. The average learning curve reported for performing HoLEP was greater than 25 cases.

Smart Sterilization Container Technology: Blue Wrap Innovation

Steam sterilization is the basis of modern surgical instrument sterilization. It is a highly effective, safe, cost-effective heat transfer method that is closely monitored and regulated. The autoclave time is typically 1 hour for sterilization and requires direct steam contact with surgical tray contents. A porous barrier, typically blue polypropylene wrap or filter, is required around or on the walls of the sterilized tray to allow steam to enter and escape. This barrier can require up to 2 hours of cooling without touching after autoclave sterilization to prevent moisture condensation and bacterial wicking. The porous barrier is fragile and can tear or develop holes which can lead to OR challenges. It is also moisture sensitive and may be an underappreciated source of surgical site infections. Porous barrier technologies create inherent inefficiencies in sterile processing and OR turnover. Electronic container technology may possibly forego the porous barrier limitations and inefficiencies by capturing a sterile vacuum seal in the autoclave. A verifiable vacuum sealed container may eliminate limited handling while cooling and may increase sterile department efficiency and reduce operating room turnover. If the technology is reliable and consistent, it may offer a safer and more durable, transportable, monitorable, sustainable sterile processing alternative than current porous barrier technologies.

An Efficiency Model for Decreasing Operative Room Turnover Time for Total Joint Arthroplasties.

Despite an increased demand for total joint arthroplasty (TJA), rising health-care costs and bundling of payments by payers have shifted the focus to improving operating room (OR) efficiency. This study aimed to assess the efficacy of an efficiency model that optimized instrument trays on decreasing OR turnover time (TOT) and the benefits made possible by this improved efficiency. All primary TJA procedures performed by a single fellowship-trained surgeon from January 2022 to August 2023 were reviewed. The surgeon partnered with Zimmer Biomet to condense the total knee and total hip arthroplasty instrument trays from seven to three trays each. Patient in OR time and patient out of OR times were collected and used to calculate TOT. Mean TOTs pre-efficiency model implementation (January - October 2022) and post-efficiency model implementation (March - August 2023) were compared. Annual cost savings were calculated based on an average cost per one minute of OR time of $47.99 and an average cost for the Sterile Processing Department (SPD) to process a single TJA tray of $79.41. Following implementation of the efficiency model, the average OR TOT significantly decreased by 19 minutes (P < 0.0001), a greater than 44% reduction in TOT. At this surgeon's current case volume, conservatively estimated at 280 primary TJA cases per year, annual savings in OR and SPD processing costs were $169,597 and $88,939, respectively. Moreover, this led to increased case volume per operative day. A small-scale intervention such as optimizing instrument trays for TJA is a valuable and sustainable solution to improve efficiency in the OR by decreasing OR TOT, thereby generating considerable cost-savings and opportunity to increase surgical volume.

Flexion contracture can cause component mismatch in the Prophecy® preoperative patient-specific instrumentation for Evolution® medial-pivot knee system.

Patient-specific instrumentation (PSI) systems are used to conduct total knee arthroplasty. PSI reduces operative time, is less invasive and easier to use, and minimizes the risk of errors by providing precise measurements and reducing operating room turnover time. However, a study on the accuracy of Prophecy Evolution PSI (Microport Inc., Arlington, TN, USA) reported that 94% were below the error margin of 1.5mm and 90% had error margins of 1mm. This study aimed to evaluate the accuracy of the Prophecy Evolution PSI system in terms of the thickness of "total" bony resection required to achieve adequate extension/flexion gaps and the component match ratio between preoperative planning and actual component size inserted. Comparisons were made between the sizes of femoral and tibial components planned with PSI and those inserted. The primary outcome was the average preoperative range of motion with and without matched femoral/tibial components. The study further analyzed the proportions of cases in which both the femoral and tibial components matched, neither matched, and only one of the femoral or tibial components matched. The ratio of the same sizes between the PSI planning and those inserted was 50.8% (33 patients) for both the femoral and tibial components. For the femoral component alone, the ratio was 84.6% (55 patients), and for the tibial component, it was 58.4% (38 patients). A receiver-operating characteristic curve analysis indicated that flexion contracture greater than 20° was a significant prognostic factor for the PSI component match group versus the mismatch group. Flexion contracture may cause PSI mismatch. Notably, flexion contracture greater than 20° was a significant risk factor for the PSI component match group versus the mismatch group. During preoperative planning for a patient with flexion contracture, surgeons should prepare for the possibility of inserting an undersized tibial component.

Taking Action Against Clinician Burnout Through Reducing the Documentation Burden With an Operating Room Supply Scanning Approach.

Documenting surgical supply items in the operating room can be a burdensome task for circulating nurses because of manual input within the electronic medical record. This can lead to documentation fatigue and contribute to nursing burnout. The aim of this quality improvement project was to design and implement a supply item scanning process and evaluate the effect on intraoperative documentation completion time, room turnover time, picklist documentation accuracy, nurse satisfaction, and burnout. The sample included nine acute care hospitals throughout the United States, with 189 total circulating nurses and 31 718 procedures occurring during the study timeframe of 8 months. Results indicated that nurses were able to complete documentation on average 37.33 minutes sooner, and the operating room turnover time decreased by 1.88 minutes. Although nurses reported that their perceived picklist documentation accuracy did not improve, and the presence of new scanning technology did not influence their hospital employment decision, subjective feedback was mostly positive, with most responses citing the helpfulness of scanning for documentation. This study shows that an interdisciplinary team can effectively work to optimize documentation efficiency and performance improvement using a scanning intervention. Lessons learned through this process can translate into optimizations elsewhere in the electronic medical record.

Separate rooms for patient induction, case set-up and breakdown: Innovative operating room turnover through quality management

Turnover time (TT) is the time it takes to prepare an operating room (OR) between consecutive surgeries. Short TT improves OR efficiency, while maintaining patient and staff safety and satisfaction. Yet the multitude of staff involved and steps required creates process complexity that can hinder this goal. Leveraging a unique case study setting, this study deploys a collection of quality management tools to investigate how the use of separate support rooms for patient induction (the administration of anesthesia), case set-up, and case breakdown can reduce OR TT while maintaining safety and satisfaction. Key results show that separate rooms for patient induction and case breakdown can enable parallel processing, improve patient and staff safety, and patient experience. We use post implementation observations to measure TT reduction when using an induction room, which allows time for an extra case per day. We develop decision-support models practitioners can use to identify the potential benefits of separate support rooms during the OR turnover, based on operating conditions and surgical characteristics. We provide considerations from buffer theory and coordination theory for the separation of physical space, proposing a novel view of the OR turnover process as a set of service modules and interfaces.

The Role of Preoperative Nurses in Decreasing Operating Room (OR) Turnover Time and Promoting the On-Time Starts of First Cases in the OR

The Role of Preoperative Nurses in Decreasing Operating Room (OR) Turnover Time and Promoting the On-Time Starts of First Cases in the OR

Surgical pit crew: initiative to optimise measurement and accountability for operating room turnover time

Background and objectivesTurnover time (TOT), defined as the time between surgical cases in the same operating room (OR), is often perceived to be lengthy without clear cause. With the aim...

An Outer Approximation Method for Scheduling Elective Surgeries with Sequence Dependent Setup Times to Multiple Operating Rooms

In this paper, operating room planning and scheduling problems have been studied. In operating room planning, the allocation of patients to operating rooms and their sequencing are critical in determining the performance of operating rooms. In this paper, three surgery scheduling decisions are considered, including the number of operating rooms to open, the allocation of surgeries to operating rooms, and the sequencing of surgeries in allocated operating rooms. All the surgeries under consideration are elective, and surgery durations are considered deterministic. Further, it is considered that the surgeries have different specialties, and each operating room can accommodate a particular specialty of surgeries, i.e., heterogeneous operating rooms are considered in the current study. Before performing a surgery, setup time is required for operating room turnover and sterilization, and it is considered sequence dependent. A mixed integer nonlinear programming (MINLP) model is developed to minimize the overtime costs of operating rooms for allocation and surgery sequencing with sequence dependent setup times. An outer approximation (OA) method is proposed to solve the problem near optimally. Experiments are conducted to compare the performance of the proposed OA method with the standard mixed integer nonlinear programming model. Computational results show the efficiency of the proposed OA method. Later, a case data from a case hospital is collected and a case study is solved.

137. Comparison of Patient Outcomes and Efficiency of Microsurgeries Performed by Single Surgeon versus Co-surgeon

INTRODUCTION: As we search for strategies to optimize operating room turnover rate, allocation of human and financial resources, and patient outcomes, surgeons may stand to benefit from co-operating with another surgeon for long and costly procedures. In Microsurgical Reconstruction literature, there has been increased attention to comparing outcomes of surgeries that used a two-surgeon approach compared to a one-surgeon approach in regards to operative times, complication rate, and so on. We today meta-analyze the outcome measures of microsurgeries performed by co-surgeons compared to single surgeons. PURPOSE: To demonstrate superior operative time, length of admission, complication rate, flap loss rate, and return to OR of microsurgeries performed by dual-surgeons versus single surgeons. METHODS: A medical librarian (LHY) searched the literature for records including concepts for dual surgeons and surgical benefits. We created search strategies using keywords and controlled vocabulary to search in databases including Embase, Ovid Medlin, Scopus, The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov. Search strategies were completed April 29, 2020 resulting in 3,035 unique citations total. Three independent reviewers reviewed the literature and included 9 studies in microsurgery to identify the following data points: publication year, country, study design, type of surgical intervention performed, number of patients in the single-surgeon group, number of patients in the co-surgeon group, operative time (OT), length of stay (LOS), post-operative complications (POC), flap loss rate (FLR), and return to OR (LOR). If no standard deviation was provided, it was calculated based on published raw data. Literature that did not compare outcomes of single-surgeon to co-surgeon, or did not investigate microsurgical interventions, were excluded. A final revision for the correct data input was performed by a single reviewer, who ran statistical analysis. Meta-analysis and forest plots were created using RevMan Version 5. RESULTS: For each dependent variable, up to 7 papers qualified for inclusion. Results showed on average, Co-surgeon procedures were 50.0 minutes shorter than single surgeon procedures(95% CI: [-79.26, -20.67]). LOS was 0.46 days shorter for patients treated by co-surgeons (95% CI: [-0.81, -0.12],). For POC, the odds ratio for patients in co-surgeon group for having complications was 0.51 (95% CI [0.34, 0.75]). There was a tendency toward a lower FLR for patients in the co-surgeon groups (OR=0.48 [0.18, 1.30], p=0.15). Similarly, there was a trend toward fewer RTO in the co-surgeon group (OR=0.60 [0.35, 1.02], p=0.06). CONCLUSION: In the healthcare environment, where resources are at time scarce, multidisciplinary team approach might yield better outcomes. The dual-surgeon approach for microsurgical intervention decreases OT, LOS, POC, FLR, and RTO. This team structure decreases morbidity and improves healthcare resource utilization. The current literature demonstrates that patients, surgical teams, and the healthcare system at large stand to benefit when there are two-surgeons at the operative table. Institutional support for this team structure should be prioritized in centers where microsurgery is performed.

Improving efficiency and reducing costs in robotic surgery: a Lean Six Sigma approach to optimize turnover time.

Operating room (OR) turnover time (TOT) is the time it takes to prepare an OR for the next surgery after the previous one has been completed. Reducing OR TOT can improve the efficiency of the OR, reduce costs, and improve surgeons' and patients' satisfaction. The objective of this study is to evaluate the effectiveness of an operating room (OR) turnover time (TOT) reduction initiative using the Lean Six Sigma methodology (DMAIC) in the bariatric and thoracic service lines. Performance improvement strategies consist of simplifying steps (surgical tray optimization) and concurrent steps (parallel task execution). We compared 2-month pre-implementation vs. post-implementation. A paired t-test was used to assess whether the difference in the measurements was statistically significant. The study found that TOT was reduced by 15.6% from an average of 35.6 ± 8.1 to minutes 30.09 ± 9.7min (p < 0.05). Specifically, in the bariatric service line, TOT was reduced by 17.15% and in the thoracic service line, TOT was reduced by 9.6%. No adverse events related to the initiative were reported. The results of this study indicate that the TOT reduction initiative was effective in reducing TOT. The efficient use of operating rooms is crucial in hospital management, as it not only impacts finances but also affects the satisfaction of surgical teams and patients. This study shows the effectiveness of Lean Six Sigma methodology in reducing TOT and improving the efficiency in the OR.

PD32-09 GOAL SETTING AND OR TURNOVER TIME: A RANDOMIZED TRIAL

You have accessJournal of UrologyCME1 Apr 2023PD32-09 GOAL SETTING AND OR TURNOVER TIME: A RANDOMIZED TRIAL Ethan Matz, Rahul Dutta, Matvey Tsivian, Ryan Terlecki, and Catherine Matthews Ethan MatzEthan Matz More articles by this author , Rahul DuttaRahul Dutta More articles by this author , Matvey TsivianMatvey Tsivian More articles by this author , Ryan TerleckiRyan Terlecki More articles by this author , and Catherine MatthewsCatherine Matthews More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Longer operating room (OR) turnover times negatively impacts hospital costs, surgeon volume, and satisfaction. Our published institutional turnover times are 30 minutes for outpatient and 40 minutes for inpatient cases. The primary aim of this randomized trial was to examine the impact of a verbalized time goal for room re-entry compared to usual care. Secondary aims were to evaluate risk factors for turnover times that exceeded specified institutional standards. METHODS: This is a prospective, single blind, randomized study in which sequential cases were randomized to receiving a verbal prompt with the goal OR return time by the attending surgeon versus usual care. Block randomization that controlled for inpatient versus outpatient OR location was administered through random sequential number generation in RedCap. From the electronic medical record, we captured data regarding turnover time, location, case type (robotic, open, transvaginal), OR staff team make-up, case order, and surgeon gender. A logistic regression analysis that controlled for location, case type, surgeon, and case order was performed to assess risk factors for prolonged turnover times. A standard power analysis was performed. RESULTS: From July through October 2022, 5 attending surgeons randomized 86 cases: 40 cases to verbal prompt vs 46 to usual care. Of these, 30 were inpatient and 56 outpatient and case mix included 8% open, 8% robotic, 36% transvaginal, 26% endoscopic and 22% other. Overall, mean inpatient and outpatient turnover time were longer than the stated institutional goals: 51.7 minutes compared to 40 minutes, and 34.8 minutes compared to 30 minutes, respectively. 30% of inpatient and 49% of outpatient cases hit the institutional goals (p=0.088). For the highest accruing surgeon, verbal prompting significantly decreased OR turnover time (33 vs 43 min, p=0.04). Vaginal surgery specifically trended towards having faster turnover time with prompting (40 vs 33 min, p=0.088). With a logistic regression model controlling for location, staff, surgeon, surgeon gender, case type, and verbal prompt, only verbal prompting was independently associated with reaching the goal turnover time (OR=3.96 [1.05-15.02], p=0.0426). CONCLUSIONS: In this prospective, single blind study, verbal instruction by the attending surgeon is independently associated with successfully reaching institutionally directed turnover times. This is a low-cost intervention that requires further study in a larger cohort. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e910 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Matz More articles by this author Rahul Dutta More articles by this author Matvey Tsivian More articles by this author Ryan Terlecki More articles by this author Catherine Matthews More articles by this author Expand All Advertisement PDF downloadLoading ...

Patient Satisfaction and Its Predictors With Perioperative Anesthesia Care at Two General Hospitals in Southwestern Saudi Arabia.

Introduction Patient satisfaction is one of the most crucial quality assessment and improvement indicators in anesthesia. Different factors reflect satisfaction such as postoperative pain, procedure duration, patient-physician relationship, inpatient services, and waiting time. A high level of satisfaction can lead to better outcomes in many ways, such as decreasing future surgeries fear and strengthening the healthcare system trust among the population. Therefore, this study aimed to evaluate the satisfaction level and its predictors with perioperative anesthesia care among patients subjected to different surgeries in two general hospitals in southwestern Saudi Arabia. Methodology A cross-sectional study was conducted among patients admitted to different surgical specialties at two general hospitals in Al-Qunfudhah governorate in October 2022. Data were collected through interviews with postoperative patients and checking their medical data from the patient's medical reports. However, all surgical patients aged more than 18 consider as inclusion. In contrast, intensive care unit (ICU) admission, local anesthesia, refusal to participate, and cognitive and communication impairment aretheexclusion. Perioperative patient satisfaction was assessed using the Leiden Perioperative Care Patient Satisfaction Questionnaire (LPPSq). Results Eighty-three of 201 patients were included in the final analysis. The overall level of patient satisfaction concerning perioperative anesthetic care was calculated to be 73.5%. Hospital setting, admission type, BMI, and smoking were statistically associated with perioperative anesthesia patient satisfaction. Additionally, the most frequently reported unpleasant anesthetic side effect was shivering, followed by postoperative pain at a frequency of 42 (50.6%) and 37 (44.6%), respectively. Conclusion A moderate level of patient satisfaction concerning perioperative anesthetic care was detected. Smoking, BMI, admission type, and hospital setting were significantly associated predictors for patients' satisfaction. In order to present a complete picture, we recommend that future research concentrate on additional elements of patient satisfaction, particularly operating room turnover and standards for discharge. Additionally, we propose a routine evaluation before patients' discharge when patients are altering and oriented. Periodic evaluation and enhancement of patient satisfaction with perioperative anesthetic care should be employed and promoted.

Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.

Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.

Contemporary Anesthesia Perspectives for Ophthalmic Surgery: A Brief Review

In recent decades there have been few changes in the anesthesia management of eye surgery. By contrast, the 21st Century has witnessed major advancements in ophthalmic surgery with the adoption of minimally-invasive techniques, technologic innovations, and an expanding population seeking eye care. These factors have impacted intraoperative exposure such that many procedures are now performed on more complex patients, and completed in quicker time. Furthermore, in pursuit of economic savings and patient satisfaction there is a trend to divert eye surgeries away from the in-hospital setting to ambulatory centers or office locations. From an anesthesia perspective, these changes have imposed a demand on providers to shorten operating room turnover times and accelerate patient discharge while maintaining high standards of patient safety. This review will address five new avenues of anesthesia care, each of which offer possibilities in accommodating facets of this new order surgical experience. First, remimazolam is an ultra-short acting benzodiazepine that produces a predictable period of hypnosis and rapid, full recovery of consciousness because of its short context-sensitive half-time and inactive metabolites. A single 3-5 mg dose produces 11-15 minutes sleep that may be ideal for brief ocular interventions. Second, nasal CPAP/BiPAP and high flow nasal oxygen devices expand the profile of patients appropriately managed at an ambulatory center. Since their application improves arterial oxygenation and delays the onset of apneic hypoxemia, they are advantageous for patients afflicted by morbid obesity or severe obstructive sleep apnea. Third, open globe injuries have traditionally been managed under general anesthesia. However, recent studies attest to regional anesthesia as a viable alternative for many ocular insults, particularly for the elderly and patients with major organ dysfunction or risk for pulmonary aspiration. Fourth, the sub-Tenon block is a cannula-based regional ophthalmic skill performed predeominantly by ophthalmic surgeons because it necessitates conjunctival incision and dissection. Recently described variations of an incision-free, easily mastered sub-Tenon approach are likely to be included in residency and fellowship instruction, and so become an invaluable component of the anesthesiology armamentarium. This review concludes with a concise overview of the a2 agonist dexmedetomidine with the focus directed on its uses as an adjunct for adult sedation, and advantage in children for premedication and control of emergence delirium.

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

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.

Surgical Pit Crew: Optimizing Measurement and Accountability for Operating Room Turnover Time

INTRODUCTION: With the aim of optimizing and standardizing operating room (OR) turnover processes and decreasing overall turnover time, we developed an innovative, staff-interactive method for measuring the time between surgical cases. METHODS: We broke down turnover into task-based sections and created buttons on the electronic medical record default pre-login screen within appropriate staff workflows to collect more granular data. We defined “Turnover Time” as the time between “Wheels out” of the previous case’s patient’s bed, to “Wheels in” of the patient’s bed for the case to follow. We created submeasures including “Cleanup Start,” “Cleanup Complete,” “Setup Start,” and “Room Ready for Patient” to calculate environmental services (EVS) response time, EVS cleaning time, Room Setup response time, and Room Setup time accordingly. RESULTS: Since developing these workflows, we have seen excellent adoption by staff members. We have also seen the times of EVS response and cleanup decrease significantly at our main hospital ORs (Fig. 1).Figure 1CONCLUSION: Delay in the OR can be costly to hospital systems, and 1 area where known delay occurs is during turnover. OR turnover can be a seemingly nebulous time between surgical cases. Many different and distinct staff personnel are often involved in many different and distinct processes during this time. By dividing our measurement of turnover time into the main processes that need to be completed, “Cleanup” and “Setup,” we were able to gain valuable insight into the cause of turnover delay and increase awareness and accountability of staff members to complete assigned tasks efficiently.

Determining the Operative Efficiency of Ankle Arthroscopy with a Standard Arthroscope vs Nanoscope

Category: Arthroscopy; Ankle Introduction/Purpose: Ankle arthroscopy is a commonly performed surgical procedure. Needle arthroscopy - performed with a nanoscope (Arthrex, Naples, FL) - has recently been introduced as an alternative to traditional arthroscopy, with goals of reducing pre-procedure set-up time, size of incisions, and minimizing soft tissue injury. To date, the efficiency of nanoscope use in ankle arthroscopy has not been investigated. The purpose of this study is to use time-driven activity-based costing (TDABC) to compare the single-use nanoscope to the reusable 2.7-millimeter small joint arthroscope in performing ankle arthroscopy procedures to understand cost and efficiency. We hypothesize that the nanoscope is the more cost-effective approach because it is not associated with the costs of reprocessing and allows for quicker operating room (OR) setup time. Methods: This is a prospective study of hand-timed collection of procedure times and a retrospective review of procedure costs. Four authors directly hand-timed ankle arthroscopy procedure setup and operative cases performed by one of two fellowship- trained foot and ankle surgeons at a single academic medical center. In total, 21 procedures were timed (arthroscope=10, nanoscope=11). Furthermore, using TDABC, we calculated procedure costs with each device. Costs of reprocessing reusable equipment, operating room time per minute (mean, $36.14/min), sterile processing, department and operating room labor, and maintenance were gathered from literature values and facility accounting systems. These direct and indirect costs were summed into the total cost for each of the surgical techniques, and a sensitivity analysis was performed to determine which of the variables had the most significant effect on overall procedure cost. Results: There was a statistically significant difference in OR opening time (arthroscope=10.28 minutes, nanoscope=4.83 minutes; p=.021) and incision to joint space time (arthroscope=2.19 minutes, nanoscope=1.26 minutes; p=.007) between devices, but no difference concerning set-up or total case intraoperative times. (Table 1) There was no difference in total OR time cost, though the nanoscope group was lower than the arthroscope group (arthroscope= $1,171.48, nanoscope=$916.60; p=.066). With regard to the costs of instrument cleaning, OR turnover, and device setup, the total cost for standard arthroscope use was $1,265.73, as compared to $968.28 for the nanoscope (p=.038). However, the use of the standard arthroscope was less costly when the OR turnover time was less than 24.18 minutes or the OR time costs were less than $26.96 per minute. Conclusion: Overall, the nanoscope was significantly more efficient than the 2.7-millimeter reusable scope regarding opening time and incision to joint space time in the OR. Ankle arthroscopy utilizing a traditional arthroscope is 30.7% more expensive than with the use of a nanoscope and takes longer to set up. Operating room cost per minute and room turnover time are the primary factors driving procedural cost. Given the similar clinical indications of both devices, understanding the cost differences between devices may assist in clinician decision-making to guide the optimization of facility procedures in the operating room.