Room Turnover Research Articles

A Prospective Study on Operation Theater Utilization Time and Most Common Causes of Delays and Cancellations of Scheduled Surgeries in a 1000-Bedded Tertiary Care Rural Hospital with a View to Optimize the Utilization of Operation Theater.

Background:The operation theater (OT) complex is a costly component of a hospital budget expenditure. This area of hospital activity requires maximum utilization to ensure optimum cost benefit. To achieve a high level of utilization in the OT, it is necessary to efficiently coordinate number of activities and personnel.Methods:This study was conducted in a 1000-bedded tertiary care teaching hospital in rural maharashtra over aperiod of two months. The OT complex consists of eight major OTs. Normal working hours for routine scheduled cases on all working days except Sundays and public holidays.Results:Total study period consisted of 96 working days. There were a total of eight OT tables of various specialties, and parameters were observed during the routine hours excluding Sundays and holidays. The total procedure time was maximum for ENT followed by orthopedics and least for obstetrics. Room turnover time was maximum for obstetrics followed by general and oncosurgery. Case delays were maximum in general surgery and least for ophthalmology. The most common reason for delay in starting the operation table was patient getting shifted late from the ward and administrative causes. The most prominent reasons for cancellation were lack of operating room time followed by medical reasons of the patient.Conclusion:We concluded that most of the causes of delays and cancellations of surgeries were avoidable with proper preoperative planning and optimization of patients and resources and good communication between surgeon anesthesiologists and the nursing staff.

Impact of a Laser Service Line for Burn Scar on a Dedicated Burn OR's Flow and Productivity.

Our group began performing erbium-YAG 2940 wavelength fractional resurfacing of burn scar in our burn center's dedicated burn operating room (OR) in January 2016. The impact of these procedures on the performance of a mature, dedicated burn OR is unknown. All burn OR cases performed between January 1, 2015 and December 31, 2015 served as a pre-laser (PRE-LSR) historical control. A postintervention cohort of laser-only cases (LSR) performed between January 1, 2016 and August 17, 2016 was then identified. PRE-LSR and LSR cases were retrospectively reviewed for OR component times, and work relative value units (wRVU) billed. A total of 628 burn OR cases were done in 2015 (PRE-LSR), while 488 burn OR cases were done between January 1 and August 17, 2016. Of these 488, 59 cases were LSR (12.1%). Calculated on a monthly basis, significantly more cases were done per day in the LSR era (2.2 ± 0.4 cases/d) than PRE-LSR (1.6 ± 2.0 cases/d; P < .0001). The LSR group was significantly shorter than the PRE-LSR group for all OR component times (induction, prep, and procedure all P < .0001; transport out, P = .01; room turnover, P = .004). Aggregate OR component time was 79.2 ± 33.4 minutes for LSR and 157.5 ± 65.0 minutes for PRE-LSR (P < .0001). LSR yielded 6.9 ± 3.2 wRVU/h, while PRE-LSR generated 12.2 ± 8.9 wRVU/h (P < .0001). Despite significantly shorter OR component times and more cases being done per day, laser treatment of burn scar using a single 17108 Current Procedural Terminology code cuts wRVUs generated per hour in a mature burn OR roughly in half.

Evaluation of a pulsed xenon ultraviolet disinfection system to decrease bacterial contamination in operating rooms

BackgroundEnvironmental cleanliness is one of the contributing factors for surgical site infections in the operating rooms (ORs). To decrease environmental contamination, pulsed xenon ultraviolet (PX-UV), an easy and safe no-touch disinfection system, is employed in several hospital environments. The positive effect of this technology on environmental decontamination has been observed in patient rooms and ORs during the end-of-day cleaning but so far, no study explored its feasibility between surgical cases in the OR.MethodsIn this study, 5 high-touch surfaces in 30 ORs were sampled after manual cleaning and after PX-UV intervention mimicking between-case cleaning to avoid the disruption of the ORs’ normal flow. The efficacy of a 1-min, 2-min, and 8-min cycle were tested by measuring the surfaces’ contaminants by quantitative cultures using Tryptic Soy Agar contact plates.ResultsWe showed that combining standard between-case manual cleaning of surfaces with a 2-min cycle of disinfection using a portable xenon pulsed ultraviolet light germicidal device eliminated at least 70% more bacterial load after manual cleaning.ConclusionsThis study showed the proof of efficacy of a 2-min cycle of PX-UV in ORs in eliminating bacterial contaminants. This method will allow a short time for room turnover and a potential reduction of pathogen transmission to patients and possibly surgical site infections.

Reducing or Delays: Cross Training and Frontline Engagement Improves Patient Flow in a Tertiary Pediatric Hospital

Arkansas Children’s Hospital is a Level I Trauma Center annually serving approximately 16,000 patients undergoing general anesthesia or deep sedation for surgeries or procedures. Previous staffing models were inflexible, limiting nursing resources by restricting staff to specific areas and resulting in increases in Operating Room (OR) turnover times and impedance to patient flow.

Reducing Operating Room Turnover Time for Robotic Surgery Using a Motor Racing Pit Stop Model.

Operating room (OR) turnover time, time taken between one patient leaving the OR and the next entering, is an important determinant of OR utilization, a key value metric for hospital administrators. Surgical robots have increased the complexity and number of tasks required during an OR turnover, resulting in highly variable OR turnover times. We sought to streamline the turnover process and decrease robotic OR turnover times and increase efficiency. Direct observation of 45 pre-intervention robotic OR turnovers was performed. Following a previously successful model for handoffs, we employed concepts from motor racing pit stops, including briefings, leadership, role definition, task allocation and task sequencing. Turnover task cards for staff were developed, and card assignments were distributed for each turnover. Forty-one cases were observed post-intervention. Average total OR turnover time was 99.2min (95% CI 88.0-110.3) pre-intervention and 53.2min (95% CI 48.0-58.5) at 3months post-intervention. Average room ready time from when the patient exited the OR until the surgical technician was ready to receive the next patient was 42.2min (95% CI 36.7-47.7) before the intervention, which reduced to 27.2min at 3months (95% CI 24.7-29.7) post-intervention (p<0.0001). Role definition, task allocation and sequencing, combined with a visual cue for ease-of-use, create efficient,and sustainable approaches to decreasing robotic OR turnover times. Broader system changes are needed to capitalize on that result. Pit stop and other high-risk industry models may inform approaches to the management of tasks and teams.

The SmartOR: a distributed sensor network to improve operating room efficiency.

Despite the significant expense of OR time, best practice achieves only 70% efficiency. Compounding this problem is a lack of real-time data. Most current OR utilization programs require manual data entry. Automated systems require installation and maintenance of expensive tracking hardware throughout the institution. This study developed an inexpensive, automated OR utilization system and analyzed data from multiple operating rooms. OR activity was deconstructed into four room states. A sensor network was then developed to automatically capture these states using only three sensors, a local wireless network, and a data capture computer. Two systems were then installed into two ORs, recordings captured 24/7. The SmartOR recorded the following events: any room activity, patient entry/exit time, anesthesia time, laparoscopy time, room turnover time, and time of preoperative patient identification by the surgeon. From November 2014 to December 2015, data on 1003 cases were collected. The mean turnover time was 36min, and 38% of cases met the institutional goal of ≤30min. Data analysis also identified outlier cases (>1 SD from mean) in the domains of time from patient entry into the OR to intubation (11% of cases) and time from extubation to patient exiting the OR (11% of cases). Time from surgeon identification of patient to scheduled procedure start time was 11min (institution bylaws require 20min before scheduled start time), yet OR teams required 22min on average to bring a patient into the room after surgeon identification. The SmartOR automatically and reliably captures data on OR room state and, in real time, identifies outlier cases that may be examined closer to improve efficiency. As no manual entry is required, the data are indisputable and allow OR teams to maintain a patient-centric focus.

Novel combination of simulation and Lean methodology to improve operating room turnover.

We describe a novel combination of medical simulation and Lean process improvement methodology applied to improve operating room (OR) turnover time (TOT). Excess OR TOT (time between one patient's exit and next patient's entry) negatively impacts throughput, patient care and revenue generation. Elimination of waste and improvement in efficiency are highly desirable. Lean methodology, applied to healthcare, seeks improvement by eliminating waste, revising processes and identifying/resolving problems at a root-cause level.1–4 Staff are engaged in change through weeklong rapid improvement events (RIE) to redesign, test and implement new work processes. An RIE includes critical assessment of the current state, mapping current processes, identification of the desired state, examination of process gaps, brainstorming improvements and experimentation to develop solutions and improve standard work.1 To address the issue of excess OR TOT, taking an OR out-of-service would be disruptive to patient care and cost-prohibitive. A simulated OR provided a potential opportunity to rapidly and repeatedly recreate the turnover process, develop and practice standard work, experiment without patient harm/disruption of care and engage staff members in designing and implementing improvements by encouraging experimentation with change. To capture this opportunity, the perioperative services, hospital-wide process improvement and simulation centre teams collaborated. ### Setting The Institute for Medical Simulation and Advanced Learning (IMSAL) and Jacobi Medical Center (JMC), a municipal hospital, Bronx, New York, …

The Association Between Operating Room Personnel and Turnover With Surgical Site Infection in More Than 12 000 Neurosurgical Cases.

Surgical site infection (SSI) contributes significantly to postoperative morbidity and mortality and greatly increases the cost of care. To identify the impact of workflow and personnel-related risk factors contributing to the incidence of SSIs in a large sample of neurological surgeries. Data were obtained using an enterprisewide electronic health record system, operating room, and anesthesia records for neurological procedures conducted between January 1, 2009, and November 30, 2012. SSI data were obtained from prospective surveillance by infection preventionists using Centers for Disease Control and Prevention definitions. A multivariate model was constructed and refined using backward elimination logistic regression methods. The analysis included 12 528 procedures. Most cases were elective (94.5%), and the average procedure length was 4.8 hours. The average number of people present in the operating room at any time during the procedure was 10.0. The overall infection rate was 2.3%. Patient body mass index (odds ratio, 1.03; 95% confidence interval [CI], 1.01-1.04) and sex (odds ratio, 1.36; 95% CI, 1.07-1.72) as well as procedure length (odds ratio, 1.19 per additional hour; 95% CI, 1.15-1.23) and nursing staff turnovers (odds ratio, 1.095 per additional turnover; 95% CI, 1.02-1.21) were significantly correlated with the risk of SSI. This study found that patient body mass index and male sex were associated with an increased risk of SSI. Operating room personnel turnover, a modifiable, work flow-related factor, was an independent variable positively correlated with SSI. This study suggests that efforts to reduce operating room turnover may be effective in preventing SSI. OR, operating roomSSI, surgical site infection.

A Patient Flow Analysis: Identification of Process Inefficiencies in a Tertiary Care Endoscopy Center

Introduction: Gastrointestinal endoscopic procedures are essential in the evaluation and treatment of gastrointestinal diseases. An aging patient population and emphasis on preventative care and surveillance have contributed to an increased demand for endoscopy. One potential approach to increase supply of endoscopy services is to improve the efficiency of endoscopy units. However, there is limited literature on the range of endoscopy unit efficiencies. The goal of this study was to identify the etiology of endoscopy delays in our endoscopy unit.Figure 1Figure 2Methods: Retrospective analysis was conducted of endoscopy suite data from April 1, 2015 through October 30, 2015 to identify the origin of delays. An observational arm further characterized the retrospective data. Results: A total of 1296 procedures were performed during this time period. Colonoscopies comprised 49% (635) of the procedures, EGD contributed 19% (244), EGD/colonoscopy 7% (85), ERCP 6% (77), upper EUS 8% (106), and upper EUS/ERCP 1% (16). All other procedures made up the remaining 10% (133). On average, the flow time (arrival to endoscopy unit to arrival in the recovery room) was 159.1 ± 63.0 min. The main bottleneck of the operation was identified as the preparation time (waiting room to procedure room) which took on average 113.9 ± 60.3 min. An additional major bottleneck was room turnover (patient exiting to next patient entering the same procedure room) with a mean turnover time of 36.5 ± 29.1 min. To isolate the exact cause of the delays within each bottleneck, a direct observation period was conducted from December 2015 to January 2016 (Table 1).Table 1: Direct observation dataLinear regression demonstrated that the flow time increased as the day progressed (r = 0.29; p < 0.05). Analysis of the variation between physicians shows that physicians have an impact on the overall flow time of the patient (p < 0.05). The type of procedure also had a significant impact on endoscopy unit efficiency (p < 0.05). Conclusion: Endoscopy units have unique operational characteristics and identification of process inefficiencies can lead to targeted quality improvement initiatives. These baseline data will be essential for future resource optimization and have identified unique opportunities for process improvement at our endoscopy center. We recommend all endoscopy units undertake efficiency analysis to determine bottlenecks and help increase patient satisfaction and decrease healthcare costs.

The Utility of Mobile Application Technology to Analyze Efficiency And Improve Operational Performance in the Endoscopy Unit

Introduction: The principles of operations management and healthcare information technology (IT) may be used together to evaluate and enhance operational performance in endoscopy centers. Previously, our group published the largest publically available endoscopy unit analysis. This “time and motion” assessment was done via data collection using a paper chart flowsheet.(1) In this study, we aim to implement a mobile app software solution and test its ability to gather endoscopy unit data and analyze efficiency in the endoscopy unit. Ultimately, we hope to validate the use of a mobile app to analyze endoscopy unit efficiency in order to perform targeted operational interventions to reduce overhead cost savings. Methods: The study was conducted over a 5-week period at a UCLA outpatient community-based endoscopy center. Endoscopy unit staff members were each given an iPad device to input operational check points involving patient flow through the endoscopy unit in real time. A variety of performance metrics were tracked for efficiency, including the True Completion Time (TCT) (scheduled procedure start time to the time the patient exited the room post-procedure), on-time starts (endoscope entry occurring within10 minutes of the scheduled time of procedure), and mean delay (time from this 10-minute mark to endoscope entry) for all cases studied. Results: We analyzed 168 patients who underwent a total of 249 procedures during the study period [42 EGD, 154 Colonoscopy, 51 EGD+Colonoscopy, 2 Flexible Sigmoidoscopy]. A total of 5 endoscopists were included in the study. The TCT was 47 minutes and room turnover time was 10 minutes across all cases studied. Ninety three percent of procedures had on-time starts, with a mean delay of 2 minutes. The average procedure duration was 39 minutes. Conclusion: The use of mobile app technology is a feasible method to implement real-time tracking and management of operational efficiency in the endoscopy center. This technique of efficiency analysis offers potential advantages compared to paper charting including automation and the potential for real-time data analysis and workflow modifications. This software-based technology may facilitate the implementation of large-scale operational efficiency and process improvement projects aimed at enhancing workflow. (1)Kaushal, et al. “Using efficiency analysis and targeted intervention to improve operational performance and achieve cost savings in the endoscopy center.” Gastrointest Endosc 2014;79:637-45.Table 1: Average Time Benchmarks, all cases studiedFigure 1

TeamSTEPPS Improves Operating Room Efficiency and Patient Safety.

The objective was to evaluate the effect of TeamSTEPPS on operating room efficiency and patient safety. TeamSTEPPS consisted of briefings attended by all health care personnel assigned to the specific operating room to discuss issues unique to each case scheduled for that day. The operative times, on-time start rates, and turnover times of all cases performed by the urology service during the initial year with TeamSTEPPS were compared to the prior year. Patient safety issues identified during postoperative briefings were analyzed. The mean case time was 12.7 minutes less with TeamSTEPPS (P < .001). The on-time first-start rate improved by 21% with TeamSTEPPS (P < .001). The mean room turnover time did not change. Patient safety issues declined from an initial rate of 16% to 6% at midyear and remained stable (P < 0.001). TeamSTEPPS was associated with improved operating room efficiency and diminished patient safety issues in the operating room.

Factors Affecting Hand Surgeon Operating Room Turnover Time.

Background: The purpose of this study was to determine the factors that affect hand surgeon operating room (OR) turnover time. We hypothesized that surgeon presence in the OR, decreased American Society of Anesthesiologists (ASA) class, smaller case type, and earlier case time, as well as other factors, decreased OR turnover time. Methods: A total of 685 hand surgery cases performed by 5 attending hand surgeons between September 2013 and December 2014 were identified. Turnover time, patient comorbidities (ASA class), surgeon, prior OR surgical procedure, current OR surgical procedure, location of the surgery (ambulatory surgical center [ASC] vs orthopedic specialty hospital [OSH]), time of surgery, and order of OR cases were recorded. The effect of surgeon routine variables, OR case factors, and patient health status on OR turnover was analyzed. Results: Turnover time was significantly shorter in cases where the surgeon remained in the OR during turnover (27.5 minutes vs 30.4 minutes) and when the surgeon incentivized OR staff (24 minutes vs 29 minutes). The ASC was found to have shorter turnover times than the OSH (27.9 minutes vs 36.4 minutes). In addition, ASA class, type of prior OR procedure, type of current OR procedure, and case order all significantly affected turnover time. Comparison of OR turnover time among the 5 surgeons revealed a statistically significant difference at the OSH but not at the ASC. Conclusion: OR turnover time is significantly affected by surgeon routine, location of surgery, patient ASA class, procedure type, and case order. Interestingly, the effect of hand surgeon routine on OR turnover time may be amplified at an academic OSH versus an ASC.

Preoperative and Intraoperative Predictive Factors of Immediate Extubation After Neonatal Cardiac Surgery

We sought to identify preoperative and intraoperative predictors of immediate extubation (IE) after open heart surgery in neonates. The effect of IE on the postoperative intensive care unit (ICU) length of stay (LOS), cost of postoperative ICU care, operating room turnover, and reintubation rates was assessed. Patients younger than 31 days who underwent cardiac surgery with cardiopulmonary bypass (January 2010 to December 2013) at a tertiary-care children's hospital were studied. Immediate extubation was defined as successful extubation before termination of anesthetic care. Data on preoperative and intraoperative variables were compared using descriptive, bivariate, and multivariate statistics to identify the predictors of IE. Propensity scores were used to assess effects of IE on ICU LOS, the cost of ICU care, reintubation rates, and operating room turnover time. One hundred forty-eight procedures done at amedian age of 7 days resulted in 45 IEs (30.4%). The IErate was 22.2% with single-ventricle heart disease. Independent predictors of IE were the absence of the need forpreoperative ventilatory assistance, higher gestational age, anesthesiologist, and shorter cardiopulmonary bypass. Immediate extubation was associated with shorter ICU LOS (8.3 versus 12.7 days; p < 0.0001) and lower cost of ICU care (mean postoperative ICU charges, $157,449 versus $198,197; p < 0.0001) with no significant difference in the probability of reintubation (p= 0.7). Immediate extubation was associated with longer operating room turnover time (38.4 versus 46.7 minutes; p= 0.009). Immediate extubation was accomplished in 30.4% of neonates undergoing open heart surgery involving cardiopulmonary bypass. Immediate extubation was associated with lesser ICU LOS, postoperative ICU costs, and minimal increase in operating room turnover time, but without an increase in reintubation rates. Low gestational age, preoperative ventilatory support requirement, and prolonged cardiopulmonary bypass time were inversely associated with the ability to accomplish IE.

Fighting Fenton Chemistry: A Highly Active Iron(III) Tetracarbene Complex in Epoxidation Catalysis.

Organometallic Fe complexes with exceptionally high activities in homogeneous epoxidation catalysis are reported. The compounds display Fe(II) and Fe(III) oxidation states and bear a tetracarbene ligand. The more active catalyst exhibits activities up to 183 000 turnovers per hour at room temperature and turnover numbers of up to 4300 at -30 °C. For the Fe(III) complex, a decreased Fenton-type reactivity is observed compared with Fe(II) catalysts reported previously as indicated by a substantially lower H2 O2 decomposition and higher (initial) turnover frequencies. The dependence of the catalyst performance on the catalyst loading, substrate, water addition, and the oxidant is investigated. Under all applied conditions, the advantageous nature of the use of the Fe(III) complex is evident.

Establishing the Learning Curve of Robotic Sacral Colpopexy in a Start-up Robotics Program

Study ObjectiveTo determine the learning curve of the following segments of a robotic sacral colpopexy: preoperative setup, operative time, postoperative transition, and room turnover. DesignA retrospective cohort study to determine the number of cases needed to reach points of efficiency in the various segments of a robotic sacral colpopexy (Canadian Task Force II-2). SettingA university-affiliated community hospital. PatientsWomen who underwent robotic sacral colpopexy at our institution from 2009 to 2013 comprise the study population. InterventionsPatient characteristics and operative reports were extracted from a patient database that has been maintained since the inception of the robotics program at Winthrop University Hospital and electronic medical records. Based on additional procedures performed, 4 groups of patients were created (A–D). Measurements and Main ResultsLearning curves for each of the segment times of interest were created using penalized basis spline (B-spline) regression. Operative time was further analyzed using an inverse curve and sequential grouping. A total of 176 patients were eligible. Nonparametric tests detected no difference in procedure times between the 4 groups (A–D) of patients. The preoperative and postoperative points of efficiency were 108 and 118 cases, respectively. The operative points of proficiency and efficiency were 25 and 36 cases, respectively. Operative time was further analyzed using an inverse curve that revealed that after 11 cases the surgeon had reached 90% of the learning plateau. Sequential grouping revealed no significant improvement in operative time after 60 cases. Turnover time could not be assessed because of incomplete data. ConclusionsThere is a difference in the operative time learning curve for robotic sacral colpopexy depending on the statistical analysis used. The learning curve of the operative segment showed an improvement in operative time between 25 and 36 cases when using B-spline regression. When the data for operative time was fit to an inverse curve, a learning rate of 11 cases was appreciated. Using sequential grouping to describe the data, no improvement in operative time was seen after 60 cases. Ultimately, we believe that efficiency in operative time is attained after 30 to 60 cases when performing robotic sacral colpopexy. The learning curve for preoperative setup and postoperative transition, which is reflective of anesthesia and nursing staff, was approximately 110 cases.

Simulation Training-a Necessity for Future Surgeons.

Simulation Training-a Necessity for Future Surgeons.

Applying Lean Problem-Solving Techniques to Improve the Efficiency of an Operating Room Team Performing Scheduled Procedures in the Labor and Delivery Department [347

INTRODUCTION: As a result of growing surgical volume, the University of Michigan implemented a dedicated surgical team to perform scheduled procedures in the labor and delivery department with the goals of starting at 8 AM, reducing case delays, and preventing cancellations. Despite implementation, health care providers at the frontline continued to observe inefficiencies. Lean problem-solving methods were used to develop a current-state analysis and to identify measures to improve efficiency (Lean problem solving has been adapted from processes applied in the manufacturing setting, where processes are examined, areas of waste are uncovered, and interventions are implemented by front-line workers). METHODS: Using Lean, the current state of the scheduled operating room team was analyzed between August and January 2013 by determining average operating room start times, performing an operating room “gemba” visit, and surveying frontline workers about observed problems and suggestions. A root-cause analysis was completed to identify key areas requiring improvement for the first plan-do-check-act cycle of quality improvement. RESULTS: Review of operating room start times for scheduled procedures was found to be 47 minutes after a goal start time of 8 AM. Lack of anesthesia availability was identified as the leading cause of delays (17.5%). Other identified areas include nursing (15.4%), preoperative laboratory completion (12.3%), operating room turnover time (12.3%), team dynamics (9.2%), addition of add-on cases (7.7%), communication (7.7%), preoperative workup (7.7%), lack of on-start time (6.2%), and other (3.1%). CONCLUSION: Application of Lean principles allowed for a systematic review of the current state of the operating room team and identification of key areas contributing to inefficiency. Consequently, targeted measures have been implemented. In this case, a dedicated anesthesia faculty has been implemented as part of the first plan-do-check-act cycle with a plan to review efficiency in 6 months.

Sa1491 Automating Endoscopy Unit Efficiency Metrics: Leveraging the Electronic Health Record for Process Improvement

Kaplan-Meier Curve: Requirement of further therapy in IBD and non-IBD patients. Sa1491 Automating Endoscopy Unit Efficiency Metrics: Leveraging the Electronic Health Record for Process Improvement Ziad Gellad*, David Chermak, Emmanuel Brown, Javad Taheri Duke University Medical Center, Durham, NC; Durham VA Medical Center, Durham, NC; Industrial and Systems Engineering, North Carolina State University, Raleigh, NC Purpose: Improving efficiency in GI endoscopy is both a business mandate and a quality imperative. Meaningful endoscopy unit efficiency metrics have been published but access to reliable time data impedes use of these measures. Methods: We developed a custom query of our electronic health record (Epic, Verona, WI) to obtain time tracking data for gastrointestinal endoscopy procedures occurring in our hospital based endoscopy unit and smaller ambulatory surgical center. Physicians in these units perform a broad array of diagnostic and therapeutic endoscopy with a mix of anesthesia and non-anesthesia sedation. To obtain time stamps, we first mapped the flow of patients through the endoscopy unit as a series of discrete events from check-in to discharge. Secondly, through a process of observation and qualitative analysis, we identified specific nursing and physician activities within the electronic health record that corresponded to the beginning and end of each discrete event. Thirdly, we identified specific data elements in the electronic record that indicated time parameters for these events. Fourth, we queried the electronic record data tables to build a custom dataset of time stamps for each completed patient encounter. Required time stamps were available in over 95% of encounters; missing time stamps were excluded from calculations. Finally, we calculated a set of efficiency metrics from this dataset that included: Procedure Volume, Room Utilization, Overtime, On-Time Start, Room Turnover Time, and Patient Waiting Time. Results: Between July 1, 2013 and June 30, 2014, we collected time stamp data on 3,741 cases in the ambulatory surgical site and 5,743 cases in the hospital based unit. Efficiency metrics, averaged monthly over the time period of collection, are outlined in the table. The ambulatory site was more efficient than the hospital based unit across all metrics. Conclusions: Through careful process mapping and workflow standardization, the electronic health record can be leveraged to collect time data for endoscopy unit efficiency metrics. Collection of these metrics can be used to benchmark against other practices and help guide process improvement activities. Average monthly endoscopy unit efficiency metrics (mean, sd)

MP16-01 TEAM STRATEGIES AND TOOLS TO ENHANCE PERFORMANCE AND PATIENT SAFETY (TEAMSTEPPS) IMPROVES OPERATING ROOM EFFICIENCY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2015MP16-01 TEAM STRATEGIES AND TOOLS TO ENHANCE PERFORMANCE AND PATIENT SAFETY (TEAMSTEPPS) IMPROVES OPERATING ROOM EFFICIENCY Matthew Stringer, Lancaster Weld, James Ebertowski, Timothy Baumgartner, Matthew Kasprenski, Jeremy Kelley, Doug Cho, Erwin Tieva, and Kyle Weld Matthew StringerMatthew Stringer More articles by this author , Lancaster WeldLancaster Weld More articles by this author , James EbertowskiJames Ebertowski More articles by this author , Timothy BaumgartnerTimothy Baumgartner More articles by this author , Matthew KasprenskiMatthew Kasprenski More articles by this author , Jeremy KelleyJeremy Kelley More articles by this author , Doug ChoDoug Cho More articles by this author , Erwin TievaErwin Tieva More articles by this author , and Kyle WeldKyle Weld More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.808AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES TeamSTEPPS is a collaborative effort by the Department of Defense and Agency for Healthcare Research and Quality to improve performance and patient safety in the healthcare environment. A commonly stated barrier to implementation of TeamSTEPPS is the time requirement of healthcare personnel during a busy operative schedule and the perceived consequential adverse effect on operating room efficiency. The purpose of this project is to evaluate the operating room efficiency during the first year of implementation of TeamSTEPPS compared to the prior year in the Department of Urology at a teaching medical center. METHODS TeamSTEPPS consisted of an initial one-time personnel training session, preoperative briefings at the beginning of each day for each operating room, and postoperative debriefings after each case. The preoperative briefing was led by the surgeon and attended by all healthcare personnel assigned to the specific operating room to discuss concerns unique to each case scheduled for that day. Postoperative debriefings identified areas for improvement. The operative times, on-time start rates, and turnover times of all cases performed by the Department of Urology during the year with TeamSTEPPS were compared to the prior year before implementation of TeamSTEPPS. RESULTS A total of 1431 cases with TeamSTEPPS and 1513 cases before TeamSTEPPS were compared. Case complexity and distribution among subspecialties were similar between the years with and before TeamSTEPPS. The mean in-room to turnover-to-surgeon time was 13.75 minutes with TeamSTEPPS compared to 14.45 minutes before TeamSTEPPS (p=0.017). The mean turnover-to-surgeon to surgical-start time was 15.19 minutes with TeamSTEPPS and 16.29 minutes before TeamSTEPPS (p=0.004). The mean surgical time with TeamSTEPPS was 72.23 minutes compared to 83.45 minutes before TeamSTEPPS (p<0.001). The on-time first-start rate was 69.8% with TeamSTEPPS while the rate before TeamSTEPPS was 48.9% (p<0.001). The mean room turnover time of 40.49 minutes with TeamSTEPPS was not significantly different than the before TeamSTEPPS time of 41.48 minutes (p=0.193). CONCLUSIONS The time requirement by healthcare personnel to participate in daily TeamSTEPPS briefings does not adversely affect operating room efficiency. TeamSTEPPS improves operating room efficiency by decreasing operating room time and increasing on-time first-start rates. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e168 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Stringer More articles by this author Lancaster Weld More articles by this author James Ebertowski More articles by this author Timothy Baumgartner More articles by this author Matthew Kasprenski More articles by this author Jeremy Kelley More articles by this author Doug Cho More articles by this author Erwin Tieva More articles by this author Kyle Weld More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP16-02 INFLUENCE OF INTERDEPARTMENTAL COLLABORATION ON UTILIZATION OF NEOADJUVANT CHEMOTHERAPY PRIOR TO CYSTECTOMY; A 14-YEAR EXPERIENCE

INTRODUCTION AND OBJECTIVES: TeamSTEPPS is a collaborative effort by the Department of Defense and Agency for Healthcare Research and Quality to improve performance and patient safety in the healthcare environment. A commonly stated barrier to implementation of TeamSTEPPS is the time requirement of healthcare personnel during a busy operative schedule and the perceived consequential adverse effect on operating room efficiency. The purpose of this project is to evaluate the operating room efficiency during the first year of implementation of TeamSTEPPS compared to the prior year in the Department of Urology at a teaching medical center. METHODS: TeamSTEPPS consisted of an initial one-time personnel training session, preoperative briefings at the beginning of each day for each operating room, and postoperative debriefings after each case. The preoperative briefing was led by the surgeon and attended by all healthcare personnel assigned to the specific operating room to discuss concerns unique to each case scheduled for that day. Postoperative debriefings identified areas for improvement. The operative times, on-time start rates, and turnover times of all cases performed by the Department of Urology during the year with TeamSTEPPS were compared to the prior year before implementation of TeamSTEPPS. RESULTS: A total of 1431 cases with TeamSTEPPS and 1513 cases before TeamSTEPPS were compared. Case complexity and distribution among subspecialties were similar between the years with and before TeamSTEPPS. The mean in-room to turnover-to-surgeon time was 13.75 minutes with TeamSTEPPS compared to 14.45 minutes before TeamSTEPPS (p1⁄40.017). The mean turnover-to-surgeon to surgical-start timewas15.19minuteswith TeamSTEPPSand16.29minutes before TeamSTEPPS (p1⁄40.004). The mean surgical time with TeamSTEPPS was 72.23 minutes compared to 83.45 minutes before TeamSTEPPS (p<0.001). The on-time first-start rate was 69.8% with TeamSTEPPS while the rate before TeamSTEPPS was 48.9% (p<0.001). The mean room turnover time of 40.49 minutes with TeamSTEPPS was not significantly different than the before TeamSTEPPS time of 41.48 minutes (p1⁄40.193). CONCLUSIONS: The time requirement by healthcare personnel to participate in daily TeamSTEPPS briefings does not adversely affect operating room efficiency. TeamSTEPPS improves operating room efficiency by decreasing operating room time and increasing on-time first-start rates.