Albert Y Huang, MD, Guillaume Joerger, MS, Remi Salmon, PhD, Brian Dunkin, MD, Vadim Sherman, MD, Barbara Bass, MD, Marc Garbey, PhD. Houston Methodist
Introduction: OR time is estimated to cost $100 per minute. Despite the significant expense of this valuable resource, best practice achieves only 70% efficiency. Compounding this problem is a lack of real-time actionable date. Most current OR utilization programs require labor intensive data entry by a member of the OR team and are subject to scrutiny. 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
Methods & Procedures: OR activity was deconstructed into four room states. A sensor network was then iteratively developed to automatically and reliably capture these states resulting in simplifying the system down to four sensors, a local wireless network, and a data capture computer (SmartOR). Two systems were then installed into two clinical operating rooms, recordings captured 24/7, and data compared to that recorded in the current OR management systems. The SmartOR recorded the following events: any room activity, patient entry/exit time, anesthesia time, laparoscopy time, room turnover time, and time surgeon identified the patient preoperatively.
Results: From November 2014 to May 2015 data was collected from 388 cases. Comparison to that in the current management system showed excellent correlation. The mean turnover time was 36 minutes. However, only 66% of cases met the institutional goal of ≤ 30 minutes. Data analysis also identified outlier cases (times > 2 SD from mean) in the domains of time from patient entry into the OR to intubation (10% of cases) and time from extubation to patient exiting the OR (13% of cases). In addition, time from surgeon identification of patient to scheduled procedure start time was 8min 4s (Institution bylaws require 30 minutes ahead of scheduled start time), yet OR teams required 17 min 56s on average to bring a patient into the room after surgeon identification. These indisputable findings correlate with the OR manager report of 74% late first-case starts due to “unavailability” of the surgeon.
Conclusions: The Smart OR automatically and reliably captures data on OR room state and, in real-time, identifies outlier cases that may be examined closer to improve efficiency. Because no manual entry is required the data is indisputable and allows OR teams to maintain a patient-centric focus.