Improving operating room efficiency through process redesign
ABSTRACT Operating rooms (ORs) are important resources for patient care and revenue, yet a significant portion of OR time is taken up by nonoperative activities. We hypothesized that redesigning the process that occurs between operations would lead to a decrease in nonoperative time (NOT = room turnover time plus anesthesia induction and emergence time).
Following a 3-month multidisciplinary planning process, a prospective study to reduce NOT was initiated in 2 of 17 ORs at a tertiary care academic medical center. Unlike previous reports, which have limited the number of participants, we constructed a process that was restricted only by case duration. The plan focused on minimizing nonoperative tasks in the OR, effecting parallel performance of activities, and reducing nonclinical disruptions. Eligible cases were those with an estimated operative time of 2 hours or less. A target NOT of 35 minutes was established. Cases of similar duration in the remaining ORs served as a concurrent control group.
Twenty-three surgeons, 13 anesthesiologists, and 11 nurses worked in the project ORs over a 3-month period. Residents participated in all cases. There was a significant reduction in NOT (42.2 +/- 12.9 vs 65 +/- 21.7 minutes), turnover time (26.4 +/- 11.2 vs 42.8 +/- 21.7 minutes), and anesthesia-related time (16.9 vs 21.9 minutes, all P < .001) in the project rooms compared with cases of similar duration in control ORs. Process-related delays were identified in 70% of cases when NOT exceeded the 35-minute target.
These results demonstrate that a coordinated multidisciplinary process redesign can significantly reduce NOT. This process is applicable to most ORs and has optimal benefit for cases of 2 hours or less in duration. The high percentage of residual process-related delays suggests that further improvements can be anticipated.
SourceAvailable from: Lizette Van Veen-Berkx[Show abstract] [Hide abstract]
ABSTRACT: Purpose - The purpose of this paper is to present the effect of the introduction of cross-functional team (CFT)-based organization, rather than, on planning and performance of OR teams. Design/methodology/approach - In total, two surgical departments of the Radboud University Nijmegen Medical Center (RUNMC) in the Netherlands were selected to illustrate the effect on performance. Data were available for a total of seven consecutive years from 2005 until 2012 and consisted of 4,046 OR days for surgical Department A and 1,154 OR days for surgical Department B on which, respectively 8,419 and 5,295 surgical cases were performed. The performance indicator "raw utilization" of the two surgical Departments was presented as box-and-whisker plots per year (2005-2011). The relationship between raw utilization (y) and years (x) was analyzed with linear regression analysis, to observe if performance changed over time. Findings - Based on the linear regression analysis, raw utilization of surgical Department A showed a statistically significant increase since 2006. The variation in raw utilization reduced from IQR 33 percent in 2005 to IQR 8 percent in 2011. Surgical Department B showed that raw utilization increased since 2005. The variation in raw utilization reduced from IQR 21 percent in 2005 to IQR 8 percent in 2011. Social implications - Hospitals need to improve their productivity and efficiency in response to higher societal demands and rapidly escalating costs. The RUNMC increased their OR performance significantly by introduction of CFT-based organization in the operative process and abandoning the so called functional silos. Originality/value - The stepwise reduction of variation - a decrease of IQR during the years - indicates an organizational learning effect. This study demonstrates that introducing CFTs improve OR performance by working together as a team.Journal of Health Organisation and Management 01/2015; 29(3):343-52. DOI:10.1108/JHOM-07-2013-0145 · 0.36 Impact Factor
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ABSTRACT: To determine the effect of local-only anesthesia on nonsurgical time compared with monitored anesthesia care (MAC)/local and general anesthesia. Our hypothesis was that local-only anesthesia cases would have lower nonsurgical times compared with MAC/local and general anesthesia. We retrospectively reviewed the surgical records of 1,179 patients undergoing elective hand surgery. For each case, we recorded the type of anesthesia used (general, MAC/local, or local-only anesthesia) and in-room presurgical time, in-room postsurgical time, and, if relevant, room turnover time. We did not record room turnover times for the first case of the day or for cases after procedures that did not meet inclusion criteria. We also recorded the presence of any anesthesia providers (anesthesiologist vs anesthesia-assistant [certified registered nurse anesthetist]). A total of 566 cases performed on 501 patients met inclusion criteria. Room turnover times were not calculated for 304 cases. The choice of anesthesia had a significant effect on nonsurgical operating room time. Local anesthesia cases had significantly less nonsurgical time compared with general anesthesia and MAC/local. Cases performed under MAC/local anesthesia also had significantly reduced nonsurgical time compared with general anesthesia. The presence of a certified anesthesia assistant had no effect on any time metrics recorded. Choice of local anesthesia, when appropriate, may facilitate rapid operating room turnover and improve overall facility efficiency with lower costs. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.The Journal of hand surgery 03/2015; DOI:10.1016/j.jhsa.2015.01.037 · 1.66 Impact Factor