Surgical team turnover and operative time: An evaluation of operating room efficiency during pulmonary resection

Introduction: Operating rooms are a scarce resource but often used inefficiently. Operating room efficiency emerges as an important part of maximizing surgical capacity and productivity, minimizing delays, and optimizing lung cancer outcomes. The operative time (time between patient entering and leaving the operating room) is discrete and the one that the surgical team can most directly influence. We performed a systematic review to evaluate the literature and identify methods to improve the efficiency of the intraoperative phase of operations for lung cancer. Methods: A literature search (in PubMed, Embase, Cochrane, and Scopus) was performed from inception up to March 9, 2020, according to the methodology described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Results: We identified 3 articles relevant to the intraoperative phase of lung cancer operating room efficiency. All 3 were consistent in showing clinically relevant time reductions in the intraoperative phase or procedures relevant to this phase. The authors demonstrated that the application of various improvement methodologies resulted in a substantial reduction in operative time, which was associated with a reduction in complications, and improved staff morale. Conclusions: Our systematic review found that various improvement methodologies have the potential to significantly reduce operative time for lung cancer surgery. This increases the value of lung cancer surgery. These findings are consistent with the wider literature on improving surgical efficiency.

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Are operating room distractions, interruptions, and disruptions associated with performance and patient safety? A systematic review and meta-analysis

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab068 ◽

2021 ◽

Author(s):

Ryan D McMullan ◽

Rachel Urwin ◽

Peter Gates ◽

Neroli Sunderland ◽

Johanna I Westbrook

Keyword(s):

Patient Safety ◽

Operating Room ◽

Random Effects ◽

Team Performance ◽

Operative Time ◽

Meta Analysis ◽

Individual Performance ◽

Negative Effects ◽

Total Operative Time ◽

Operative Duration

Abstract Background The operating room (OR) is a complex environment in which distractions, interruptions, and disruptions (DIDs) are frequent. Our aim was to synthesise research on the relationships between DIDs and (a) operative duration, (b) team performance, (c) individual performance, and (d) patient safety outcomes; in order to better understand how interventions can be designed to mitigate the negative effects of DIDs. Methods Electronic databases (MEDLINE, Embase, CINAHL, PsycINFO) and reference lists were systematically searched. Included studies were required to report quantitative outcomes of the association between DIDs and team performance, individual performance, and patient safety. Two reviewers independently screened articles for inclusion, assessed study quality, and extracted data. A random effects meta-analysis was performed on a subset of studies reporting total operative time and DIDs. Results Twenty-seven studies were identified. The majority were prospective observational studies (n=15), of moderate quality (n=15). DIDs were often defined, measured, and interpreted differently in studies. DIDs were significantly associated with: extended operative duration (n=8), impaired team performance (n=6), self-reported errors by colleagues (n=1), surgical errors (n=1), increased risk and incidence of surgical site infection (n=4), and fewer patient safety checks (n=1). A random effects meta-analysis showed that the proportion of total operative time due to DIDs was 22.0% (95% CI 15.7-29.9). Conclusion DIDs in surgery are associated with a range of negative outcomes. However, significant knowledge gaps exist about the mechanisms that underlie these relationships, as well as the potential clinical and non-clinical benefits that DIDs may deliver. Available evidence indicates that interventions to reduce the negative effects of DIDs are warranted, but current evidence is not sufficient to make recommendations about potentially useful interventions.

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Variability in Anesthesia Models of Care in Cardiac Surgery

Surgeries ◽

10.3390/surgeries2010001 ◽

2021 ◽

Vol 2 (1) ◽

pp. 1-8

Author(s):

Dianne McCallister ◽

Bethany Malone ◽

Jennifer Hanna ◽

Michael S. Firstenberg

Keyword(s):

Cardiac Surgery ◽

Best Practices ◽

Operating Room ◽

Models Of Care ◽

Surgical Team ◽

Cardiac Anesthesia ◽

Complex Environment ◽

Surgical Case ◽

Cardiac Procedures ◽

Cardiac Operations

The operating room in a cardiothoracic surgical case is a complex environment, with multiple handoffs often required by staffing changes, and can be variable from program to program. This study was done to characterize what types of practitioners provide anesthesia during cardiac operations to determine the variability in this aspect of care. A survey was sent out via a list serve of members of the cardiac surgical team. Responses from 40 programs from a variety of countries showed variability across every dimension requested of the cardiac anesthesia team. Given that anesthesia is proven to have an influence on the outcome of cardiac procedures, this study indicates the opportunity to further study how this variability influences outcomes and to identify best practices.

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Identification and use of operating room efficiency indicators: the problem of definition

Canadian Journal of Surgery ◽

10.1503/cjs.020712 ◽

2013 ◽

Vol 56 (4) ◽

pp. 224-226 ◽

Cited By ~ 17

Author(s):

Tamas Fixler ◽

James Wright,

Keyword(s):

Operating Room ◽

Operating Room Efficiency ◽

Efficiency Indicators

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Pre-Surgical Huddles Improve Operating Room Efficiency and Teamwork [25D]

Obstetrics and Gynecology ◽

10.1097/01.aog.0000514371.91739.7c ◽

2017 ◽

Vol 129 ◽

pp. 48S

Author(s):

Kathie Hullfish ◽

Keith Morris ◽

Elizabeth Hall ◽

George Rich

Keyword(s):

Operating Room ◽

Operating Room Efficiency ◽

Improve Operating Room ◽

Improve Operating

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An assessment of the quality indicators of operative and non-operative times in a public university hospital

Einstein (São Paulo) ◽

10.1590/s1679-45082015gs3289 ◽

2015 ◽

Vol 13 (4) ◽

pp. 594-599 ◽

Cited By ~ 5

Author(s):

Altair da Silva Costa Jr ◽

Luiz Eduardo Villaça Leão ◽

Maykon Anderson Pires de Novais ◽

Paola Zucchi

Keyword(s):

Standard Deviation ◽

Operating Room ◽

Operative Time ◽

Patient Flow ◽

Cross Sectional Study ◽

Public University ◽

Major Effect ◽

University Hospital ◽

Cross Sectional ◽

Using Data

ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

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