Discovering the barriers to efficient robotic operating room turnover time: perceptions vs. reality

Background Most studies on operating room (OR) efficiency have focused on how local factors within the surgical facilities (micro level), such as turnover time, case duration and non-operative time, affects operating room efficiency. Few studies have analyzed how different strategies for organizing surgical services on the departmental or hospital level (macro level) might affect OR efficiency. Norwegian hospitals have organized their surgical services on the macro level along two different strategies. Most hospitals have separate facilities for out-patient surgery and in-patient surgery, often also geographically separated. Most hospitals also have specialty specific OR (orthopedics, gastroenterology, gynecology etc.), while in other hospitals different subspecialties share the same OR. This study was undertaken to analyze any effect of these different organizational strategies in relation to OR efficiency. Methods Data on organization of surgical services and operation volume for 2009 was gathered from eleven Norwegian university and larger county hospitals with a similar case mix. Total OR efficiency and OR efficiency during ordinary work hours were analyzed separately for out-patient and in-hospital surgery, including emergency operations. Calculation of OR during ordinary hours (8am-3pm) was based on 230 workdays per year, and included emergency operations. Results OR efficiency was 721 operations per OR per year with a range from 525 to 1049 and was not related to the different strategies for organizing these services. Furthermore, no correlation was found between OR efficiency and operation volume or number of OR. OR efficiency during ordinary hours and workdays was 3.6 operations per day for out-patient surgery and 1.8 for in-patient surgery including emergency operations. This was considerably less than standards used in planning surgical facilities in Norwegian hospitals. Conclusion OR efficiency is probably more related to organization of the surgical services on the micro level than to strategies for organizing these services on the macro level. The large variation in operating room efficiency in Norwegian hospitals indicates that many hospitals have a potential for improvement. The discrepancy between actual OR efficiency and standards used for planning of surgical facilities represents a challenge in future hospital planning.

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Use of Anesthesia Induction Rooms Can Increase the Number of Urgent Orthopedic Cases Completed within 7 Hours

Anesthesiology ◽

10.1097/00000542-200508000-00024 ◽

2005 ◽

Vol 103 (2) ◽

pp. 401-405 ◽

Cited By ~ 66

Author(s):

Paulus M. Torkki ◽

Riitta A. Marjamaa ◽

Markus I. Torkki ◽

Pentti E. Kallio ◽

Olli A. Kirvelä

Keyword(s):

Operating Room ◽

Turnover Time ◽

Anesthesia Induction ◽

Prospective Analysis ◽

New Model ◽

The Mean ◽

Time Savings ◽

Working Day ◽

Room Model ◽

The Impact

Background Mean turnover times and the time spent in the operating room (OR) can be reduced by concurrent induction of anesthesia. Previous studies of anesthesia induction outside the OR have concentrated either on anesthesia-controlled time or turnover time. The goal of this study was to investigate the impact of an induction room model on the whole surgical process, its phases and delays between the phases, and the number of cases performed during the 7-h working day. Methods A prospective analysis of OR times was conducted for 5 weeks with the traditional induction-in-the-OR model followed by 4 weeks with a new model: A team of two nurses and one anesthesiologist was added to one OR to perform parallel anesthesia induction in a separate induction room. The durations of phases of surgical process, number of completed cases between 7:45 am and 3:00 pm, and daily raw utilization of the OR were assessed. Results were compared to those measured before the intervention. Results The mean nonoperative time was reduced by 45.6%, whereas surgery time remained unchanged. The time savings contributed to the concurrent anesthesia induction and the cut down in delays between the phases. The new model allowed one additional case to be performed during the 7-h working day. Conclusions Anesthesia induction outside the OR can increase the number of surgical cases performed during a regular workday.

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Interdisciplinary Work Flow Assessment and Redesign Decreases Operating Room Turnover Time and Allows for Additional Caseload

Yearbook of Anesthesiology and Pain Management ◽

10.1016/s1073-5437(08)70247-x ◽

2007 ◽

Vol 2007 ◽

pp. 273-274

Author(s):

M.F. Roizen

Keyword(s):

Operating Room ◽

Turnover Time ◽

Work Flow ◽

Interdisciplinary Work

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Decreasing Operating Room Turnover Time: A Resource Neutral Initiative

Journal of Medical Systems ◽

10.1007/s10916-018-0950-5 ◽

2018 ◽

Vol 42 (5) ◽

Author(s):

Shawne Olson ◽

Stephanie Jaross ◽

Gail S. Rebischke-Smith ◽

Frank Chivers ◽

Stephanie K. Covel ◽

...

Keyword(s):

Operating Room ◽

Turnover Time

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Causes and Effects of Inefficient Operating Room Flow during Working Hours in a University Hospital

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.09.9953 ◽

2020 ◽

Vol 103 (9) ◽

pp. 897-903

Keyword(s):

Operating Room ◽

Elective Surgery ◽

Tertiary Care ◽

Working Hours ◽

Turnover Time ◽

University Hospital ◽

Or Efficiency ◽

Average Delay ◽

First Case ◽

Cancellation Rate

Background: Operating rooms (ORs) are major source of both hospitals’ revenue and expenses; hence, OR efficiency is not only essential, but challenging for providing high-quality care, whilst utilizing limited resources. Materials and Methods: A prospective, observational study was conducted in a tertiary care university hospital to identify both causes and effects of inefficient OR flow, including the rate of first case tardiness, time delays while patients are in room, turnover time, cancellation rate, and OR-overutilization. Patients scheduled for elective surgery between September 2014 and February 2015 were recruited. Results: Three thousand nine hundred sixty-five elective surgical cases were recruited. The rate of first case tardiness was 48%. The average delay time of the first case was 25±16.6 minutes, with the main cause being late arrivals of surgical teams (97.4%). The rate of time delay while the patients were in room, was 73.2%. This is being associated with both the surgical and the anesthesia teams (83%), as well as positioning and procedures-related to the general anesthesia. The delay in turnover time was 12.9% with an average of 32.3±23.3 minutes, with most common causes being swapping of cases between ORs (22.7%) and delays in transferring patients from the ward (21.7%). The cancellation rate was 11.8%, with General surgery having the highest rate (15.5%) due to insufficient OR time (26.2%). Sixty-four-point-eight percent of the operations continued after working hours, with an average of 121.7±106.1 minutes (range 4 to 670 minutes). Conclusion: The present study identified five process points of OR inefficiency in a university hospital, demonstrating that there are substantial opportunities for enhancement of OR efficiency. Keywords: Efficiency, Operating room, First case, Tardiness, Cancellation, Turnover time, Utilization

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Reasons for delay in turnover time in operating room- an observational study

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v16i2.27473 ◽

2017 ◽

Vol 16 (2) ◽

pp. 245-251 ◽

Cited By ~ 1

Author(s):

Mohinder Kumar ◽

Suchitra Malhotra

Keyword(s):

Quality Improvement ◽

Operating Room ◽

Time Delays ◽

Medical Science ◽

Turnover Time ◽

Team Work ◽

Medical College ◽

Productive Area ◽

Productive Time

Background: Operating room (OR) like casualty room is the most productive area of a hospital. Turnover time although is a non-productive time in the operating room, yet it is important. Its efficient utilisation require multidisciplinary team work especially supporting services which play a major role in reducing turnover time in the operating room. Since present medical college where study was being conducted is still in its evolving stage, it was considered desirable for its quality improvement to study various factors which are contributing in turnover time delay so that appropriate measures can be taken to prevent the undue turnover time delay.Materials and methods: Present prospective observational case study aims at measurement of turnover time delays during 100 working days which were completed over four months for two operation theatres. The variable chosen was the delay of turnover time from the benchmark time taken. The data were collected, compiled and analysed.Results: In orthopaedics OR 77% of turnovers were found within benchmark limits. Only in 23% cases turnovers were delayed. 47% of times hospital related issues were responsible. In surgery OR 79% of turnovers were within benchmark limits. 21% cases were delayed; of this hospital related problems caused delayed turnovers in 53% cases.Conclusions: The study concluded that reasons for delays centred on multifactorial reasons which were unavoidable and unpredictable. But if those problems that can be easily fixed are attended to, valuable time can be saved, which will ultimately keep the surgeries on schedule and will prevent cancellation of elective cases. The utilization of OT complex can be optimized by team effort, multitasking and parallel processing.Bangladesh Journal of Medical Science Vol.16(2) 2017 p.245-251

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