Megan Sippey, MD, Ryan Juza, MD, Jeffrey Marks, MD, FACS, FASGE, Raymond Onders, MD, FACS, FASGE. Case Western Reserve University
Introduction: Operating room (OR) time is a significant cost and source of income for hospitals. Inefficient utilization can lead to late-in-the-day starts or inability to add on semi-urgent cases. OR efficiency is not just room turnover. Yet, many OR managers focus on first case on-time starts and turnover times to improve efficiency. Entering the OR to time of skin incision, and skin closure to exiting the room account for a significant amount of OR utilization. The aim of this study was to evaluate the efficiency of these points of patient care.
Methods: A retrospective review of prospectively collected data was performed at a single, large academic hospital. All surgical procedures performed in the OR over a 10-month period were analyzed as part of a process improvement analysis. Subgroup analysis by surgical specialty was performed, followed by a qualitative analysis of the surgical team with the highest efficiency.
Results: Data from 11,497 cases were analyzed, across all surgical subspecialties. Average time from entering the room to incision was 36.6 minutes. Subgroup analysis of general surgeons was performed. This included 4,591 cases among 30 surgeons. All surgeons performed at least 10 cases monthly. All cases were performed with resident involvement. Average time from entering the room to incision was 38 minutes—20% of the patient’s total OR time. There was great variability among surgeons, with individual surgeon averages ranging from 11 to 51 minutes. Skin closure to exiting the room averaged 14 minutes among general surgeons—7% of the total OR time.
Steps utilized by the most efficient surgeon included: Surgeon always present in room—no delay for time-out or questions about equipment and positioning. Teamwork with anesthesia for prepping and draping during induction. Video equipment confirmed functional before intubation. Incision performed at time of intubation. No muscle relaxants given after intubation. Extensive local anesthetic use, including TAP block. Patient extubated during skin closure. If patient slow to extubation, transferred to gurney while intubated. This allows OR nurses to break down and begin cleaning prior to the patient leaving. Attending surgeon only leaves when patient leaves, which assures OR team there will be no unexpected problems with residents finishing the case.
Conclusions: Significant variability exists in time from OR entry to skin incision, and skin closure to exit. Redefining standard processes, including nursing and anesthesia collaborations, can improve OR efficiency and lead to greater utilization of the OR with ensuing revenue generation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94749
Program Number: S160
Presentation Session: OR Efficiency & Outcomes
Presentation Type: Podium