The Efficiency of a Dedicated Staff on Operating Room Turnover Time in Hand Surgery

doi:10.1016/j.jhsa.2013.09.039

The Journal of Hand Surgery

Volume 39, Issue 1, January 2014, Pages 108-110

https://doi.org/10.1016/j.jhsa.2013.09.039 Get rights and content

Purpose

To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice.

Methods

A total of 621 sequential hand surgery cases were retrospectively reviewed. Turnover times for sequential cases were calculated and analyzed with regard to the characteristics of the OR staff being primarily orthopedic or nonorthopedic.

Results

A total of 227 turnover times were analyzed. The average turnover time with all nonorthopedic staff was 31 minutes, for having only an orthopedic surgical technician was 32 minutes, for having only an orthopedic circulator was 25 minutes, and for having both an orthopedic surgical technician and a circulator was 20 minutes. Statistical significance was seen when comparing only an orthopedic surgical technician versus both an orthopedic circulator and a surgical technician and when comparing both nonorthopedic staff versus both an orthopedic circulator and a surgical technician.

Conclusions

OR efficiency is being increasingly evaluated for its effect on hospital revenue and OR staff costs. Reducing turnover time is one aspect of a multifaceted solution in increasing efficiency. Our study showed that, for hand surgery, orthopedic-specific staff can reduce turnover time.

Type of study/level of evidence

Economic/Decision Analysis III.

Section snippets

Materials and Methods

After approval by our institutional review board, we conducted a retrospective review of K.S.M.'s case logs for hand surgery cases from July 2011 to June 2012 at our level I academic institution. All cases were performed in our outpatient ambulatory surgery center, located within the main hospital. A total of 621 sequential cases were identified, and operative records were reviewed. Cases included for evaluation were elective hand-specific cases regardless of patient age and running

Results

A total of 227 turnover times were included. Of these, 53 turnovers were performed with both nonorthopedic circulators and surgical technicians, 71 turnovers were performed with an orthopedic surgical technician and a nonorthopedic circulator, 34 turnovers were performed with a nonorthopedic surgical technician and an orthopedic circulator, and 69 turnovers were performed with both an orthopedic surgical technician and an orthopedic circulator.

The average turnover time in all cases,

Discussion

Increasing OR efficiency is a multifaceted task that includes turnover time, Dexter⁸ and Patterson² advised that hospitals should focus on other aspects of OR efficiency such as perioperative nursing preparation, communication within the OR, and anesthesia policies such as performing pre-procedural regional blocks. However, their advice was based on observing multiple specialties with operations requiring long operative times. Hand surgery, with many procedures of less than 1 hour long, falls

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P. Patterson
Time busters: a lean team tackles OR turnover
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P. Patterson
Restructuring circulator nurse role aids turnover
OR Manager
(2012)

There are more references available in the full text version of this article.

Cited by (43)

Intraoperative Challenges in Hand Surgery
2024, Orthopedic Clinics of North America
Improving OR efficiency by streamlining patient transfer in hand and upper extremity surgery
2023, Perioperative Care and Operating Room Management
Inefficiencies in the OR such as slow patient transfers can have a negative financial impact and affect patient safety. This study sought to determine whether decreasing the number of patient transfers in hand, wrist, and elbow surgery can improve patient flow from the time they arrive in the operating room to the time they arrive in the post-operative anesthetic unit (PACU).
Elective cases performed between April to August 2022 were retrospectively reviewed at two surgical centers. The pre-operative wait time (arrival time into the OR to the start of surgery); post-operative transfer time (end of surgery to when the patient leaves the OR); emergence time (when the patient leaves the OR to arrival in the PACU; and total patient flow time (entry into OR until arrival in PACU) were analyzed. Data from procedures where patients remained on their surgical bed (group 1) were compared against procedures where patients were transferred to and from the OR table (group 2).
Data from 259 cases (group 1 n = 191, group 2 n = 68 cases) were collected. There were significant differences between: the pre-operative wait time (p < 0.001; 95% CI, 15:40 to 17:36); post-operative transfer time (p = 0.001; 95% CI, 3:25 to 5:59); emergence time (p = 0.02; 95% CI, 1:36 to 2:02); and total flow time (p < 0.001; 95% CI, 1:05:39 to 1:21:20). The average differences between the two groups in each phase are 3–9 min. There was no difference between the types of procedures performed (p > 0.05); the average difference in total flow time was 50 min.
Keeping patients on the same surgical bed for hand, wrist, and elbow procedures can help maximize OR efficiency in an outpatient ambulatory care setting.
Dollars and Sense: The Business of Pediatric Surgery
2023, Journal of Surgical Research
This study evaluated North American pediatric surgeons’ opinions and knowledge of business and economics in medicine and their perceptions of trends in their healthcare delivery environment.
We conducted an elective online survey of 1119 American Pediatric Surgical Association members. Over 8 mo, we iteratively developed the survey focused on four areas: opinion, knowledge, current practice environment, and trends in practice environment over the past 5 y.
We received 227 (20.3%) complete surveys from pediatric surgeons. One hundred ninety four (85.5%) perceive healthcare as a business and most (85.9%) believe healthcare decisions may affect patients’ out-of-pocket expenses. More than half (51.1%) of surgeons believe it has become more challenging to perform emergent cases and most believe staff quality has decreased for elective (56.4%) and emergent (63.0%) cases over the past 5 y.
Pediatric surgeons recognize that medicine is a business and have concerns regarding the decreasing quality of operating room staff and the increasing difficulty providing surgical care over the last 5 y.
Impact of WALANT Hand Surgery in a Secondary Care Hospital in Spain. Benefits to the Patient and the Health System
2023, Journal of Hand Surgery Global Online
The aim of this study is to compare patient benefits and economic costs of hand surgeries using the wide-awake local anesthesia no tourniquet (WALANT) technique versus a conventional major outpatient suite and review outcomes and complications in a series of cases of patients operated on using the WALANT technique.
A prospective cohort study was first conducted comparing 150 cases of ambulatory hand surgery (carpal tunnel syndrome and trigger finger) using the WALANT technique and not requiring an operating room setting with 150 cases of outpatient surgery performed in an operating room involving a preoperative evaluation and the use of sedation and tourniquet. Preoperative, intraoperative, and postoperative pain was monitored, and days requiring postoperative analgesia were recorded. The resources and costs were evaluated. and patient satisfaction was assessed using a specific survey.
Subsequently, 580 patient medical records were retrospectively reviewed, including 419 carpal tunnel syndrome and 197 trigger finger interventions (616 WALANT surgeries).
Intraoperative pain was equivalent for both groups, and postoperative pain was significantly lower in the WALANT group, with a reduced need for analgesics. Satisfaction was greater for the local anesthesia group. The use of personnel resources and hospital materials was reduced in the WALANT group, with a total estimated cost savings of 1.019 USD per patient.
There were no complications related to the WALANT technique and the lidocaine and adrenaline combination. We found a complication rate of 5.58%, and, in line with the literature, most complications were minor, managed conservatively, and not related to the anesthetic technique.
Procedures such as carpal tunnel and trigger finger surgeries can be safely performed using wide-awake surgery. Patient satisfaction is higher than with the conventional procedure performed in the operating room. Pain control is excellent, especially during the postoperative period.
Hand surgery patients benefit from the WALANT technique in terms of comfort and timeliness because there is no need for preoperative tests or evaluations. In addition, it represents significant savings in hospital resources. In our case series, complications were in line with those previously reported with other anesthetic techniques.
Specific Factors Affecting Operating Room Efficiency: An Analysis of Case Time Estimates
2022, Journal of Hand Surgery
Operating room (OR) efficiency has an impact on surgeon productivity and patient experience. Accuracy of case duration estimation is important to optimize OR efficiency. The purpose of this study was to identify factors associated with inaccurate case time estimates in outpatient hand surgery. A better understanding of these findings may help to improve OR efficiency and scheduling.
All outpatient hand surgical cases from 2018 to 2019 were reviewed. Poorly-estimated cases (i.e., poor scheduling accuracy) were defined as those cases where the actual operative time differed from the predicted time by >50% (either quicker by >50% or slower by >50% than the predicted time). The percentages of poorly-estimated cases were analyzed, categorized, and compared by surgeon, procedure type, and scheduled case length.
A total of 6,620 cases were identified. Of 1,107 (16.7%) cases with poorly estimated case durations, 75.2% were underestimated. There was no difference in the likelihood of poor estimation related to start time. Well-estimated cases tended to have longer scheduled case duration, but shorter realized case duration and surgical time. Our systems analysis identified specific surgeons and procedures as predictable outliers. Cases scheduled for 15–30 minutes frequently were inaccurate, whereas cases scheduled for 30–45 and 106–120 minutes had accurate estimates.
The accuracy of case time estimations in a standard outpatient hand surgery practice is highly variable. Nearly one-fifth of outpatient hand surgery case durations are poorly estimated, and inaccurate case time estimation can be predicted based on surgeon, procedure type, and case time.
Maximizing OR efficiency should be a priority for surgeons and hospital systems. With multiple surgeries done per day, the efficiency of the OR has an impact on surgeon productivity and patient experience.
Operating room efficiency and cost reduction in shoulder arthroplasty: is there an advantage of a dedicated operating room team?
2021, Seminars in Arthroplasty JSES
Operating room (OR) efficiency is a crucial component in the delivery of high quality, cost-efficient healthcare in orthopedic shoulder arthroplasty, and generally in surgery. Utilizing a dedicated OR team may lead to higher clinical efficiency by potentially reducing total OR time and cost while avoiding operational redundancies or errors. The purpose of this study is to identify specific parameters influencing OR efficiency with a 2-roomed system with dedicated OR staff and evaluate its influence on operational cost of the OR per min.
From 2017 to 2018, 348 patients underwent primary shoulder arthroplasty at one institution, that had 2 established OR systems: A traditional “1-room” system (TS) with general OR staff, and a “2-room” shoulder service (SS) with a dedicated OR team. Medical health records were accessed to obtain pertinent study data, which included demographics, surgical indication, and time-points per surgical case. Anesthesia preparatory time (APT) was time from patient OR entry to skin incision; surgery time (ST) – from skin incision to skin closure; conclusion time (CT) – from skin closure to patient exiting OR; and turnover time (TT) – time from 1 patient's exiting to the next patient's admittance into the OR. Nonoperative time was a summation of APT, CT, and TT, while Total OR time comprised of nonoperative time and ST. Cost equivalent per minute OR operation was then used to calculate differences between the 2 interest groups.
The SS treated 270 patients (77.6%) and TS treated 78 patients (22.4%). The SS demonstrated a 74 minutes decrease in total OR time (116 vs. 190 minutes) when compared to the TS (P< .0001). When surgeon factor (“surgery time”) was removed, the SS consistently demonstrated a 23-minute decrease in nonoperative time (76 vs. 99 minutes, P< .0001) and a 26-minute decrease in turnover time (14 vs. 40 minutes, P< .0001) – about a 3-fold reduction. When analyzing cost, the SS demonstrated a $291 decrease in nonoperative cost per case ($1090 vs. $1381, P< .0001) despite the staffing cost of 3 floating staff members. The TT reduction translated to $360 savings in OR cost per case ($198 vs. $558, P< .0001).
A dedicated OR team using 2 ORs improves both clinical efficiency (decreases total OR time) and reduces cost (decreases total OR cost) - despite having more staff members and associated staffing costs - compared to a traditional 1-room system. When surgeon-specific factors were removed, the largest reduction in OR cost was associated with decrease in turnover time.
Level III.

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Scientific articleThe Efficiency of a Dedicated Staff on Operating Room Turnover Time in Hand Surgery

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Results

Discussion

AORN J

Innovative approaches to turnover time

OR Manager

Time busters: a lean team tackles OR turnover

OR Manager

Restructuring circulator nurse role aids turnover

OR Manager

Scientific article
The Efficiency of a Dedicated Staff on Operating Room Turnover Time in Hand Surgery