A surgeon-led model to improve operating theatre change-over time and overall efficiency: A randomised controlled trial

Mizumoto, Ryo; Cristaudo, Adam; Hendahewa, Rasika

doi:10.1016/j.ijsu.2016.04.033

Cited by 28 publications

(24 citation statements)

References 12 publications

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“…This protocol not only serves to clarify roles and educate OR team members on case details but signals to team members that the surgeon has thoroughly prepared and that guidance and leadership can be expected. The literature strongly supports this concept that surgeon‐led communication can alter OR dynamics and efficiency . A Johns Hopkins study examining preoperative briefings found that delays in care were reduced by up to 82% when a surgeon‐led 2‐minute standardized briefing was used immediately before the case .…”

Section: Discussionmentioning

confidence: 94%

Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation

et al. 2019

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Objectives: To assess whether manual jet ventilation can safely be performed with variable anesthesia and operating room (OR) staff experience levels and communication skills.Methods: Jet ventilation procedures for airway stenosis at a single institution over 35 months were retrospectively reviewed. OR and anesthesia staff were assigned scores based on experience level and communication skills. Data were analyzed for any association between the experience or communication skills of the staff and the successful use of jet ventilation, complication rate, or ultimate patient outcome, controlling for intraoperative variables and patient and airway complexity. A detailed preoperative surgeon-led communication protocol was followed in all cases.Results: Seventy procedures in 46 patients were performed. Jet ventilation was successful in 69 of 70 cases. No relationship was found between staff experience or communication scores and the successful use of jet ventilation, complication rate, or ultimate patient outcome. The percentage of cases performed with a fully experienced team was low, at 7.1%. The experience level of the certified registered nurse anesthetist was significantly associated with likelihood of using an adequate paralytic dose upfront (P = 0.017), which in turn correlated with shorter anesthesia time by 19.7 minutes (P = 0.0131); however, neither affected complication rate nor ultimate patient outcome. The statements above remained true in cases of medically complex patients, difficult airways with high degrees of stenosis, and multiple shift changes.Conclusions: Manual jet ventilation can be performed safely even in settings of lower staff experience level or communication skills given a surgeon experienced in the technique and a strict communication protocol.Key Words: Manual subglottic jet ventilation, operating room communication, anesthesia and surgeon cooperation, experience level in jet ventilation, endoscopic surgery for airway stenosis.

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Section: Discussionmentioning

confidence: 94%

Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation

et al. 2019

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“…[4,12,13,[26][27][28][29][30] Factors influencing productivity and timeliness using the turnover time measure have been reported in numerous OR efficiency studies. [12,21,26,[31][32][33][34][35][36] As was noted in the Canadian Paediatric Surgical Wait Times Project, a lack of a standard methodology for measuring the outcomes in these studies limits the ability to benchmark externally. [4] While there is a plethora of literature focusing on OR efficiency, to our knowledge this is the first study using a matrix of four metrics to measure, benchmark and report monitor OR efficiency that can benchmark improvements over time.…”

Section: Discussionmentioning

confidence: 99%

The impact of benchmarking operating room efficiency within the Veterans Health Administration

Lynn

Bronson²,

Gunnar

2018

IJH

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Purpose: The Department of Veterans Affairs (VA) provides surgical care and services through a network of Veterans Health Administration (VHA) Surgical Programs. This study examined the impact of benchmarking on improvements in VHA surgery program operating room efficiency.Methods: The VA National Surgery Office (NSO) developed the operating room (OR) Efficiency Matrix with four common metrics that characterize OR processes. The OR Efficiency Matrix assigned a performance level to each VHA Surgery Program identified in the NSO Quarterly Report. The NSO Quarterly Report provided ongoing and regular feedback allowing VHA Surgery Programs to develop action plans and improve performance.Results: Beginning with the Fiscal Year (FY) 2013 Quarter (Q) 2 NSO Quarterly Report, the NSO has been reporting to VHA Surgery Programs on the OR Efficiency Matrix through several tables and figures in the NSO Quarterly Report. Overall, raw metric rates have improved nationally, with most improvements coming in the metrics of OR first time starts and surgical case cancellation.Conclusions: The NSO developed and implemented the OR Efficiency Matrix, representing four well recognized metrics, to assess, track, and report OR efficiency at 137 VHA Surgery Programs. This internal benchmarking process and data reporting was associated with sustainable improvements in OR efficiency over time.

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“…The impact of a single surgeon team-based work practice model translated into 58% reduction in median change-over time and no cancellations due to lack of time in the intervention group compared with 37 cancellations in the control group [13].…”

Section: Discussionmentioning

confidence: 99%

An evaluation of operating room throughput in a stand-alone soft-tissue trauma operating theatre

O’Donnell

Walsh

Murphy

et al. 2017

Rom J Anaesth Int Care

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Background. Operating room time is a limited, expensive commodity in acute hospitals. Strategies aimed at reduction of non-operative time improve operating room throughput and capacity. We conducted a prospective study to evaluate and augment operating room throughput and capacity using context-specific work practice changes.Methods. Following institutional and ethical approval, an interdisciplinary group designed and introduced a series of work practice changes specific to a stand-alone soft tissue trauma theatre, comprising modifications to patient processing, staff behaviours and additional anaesthesiologist hours. Time intervals relating to each patient were measured during a 16 week period before and after implementing work practice changes. The primary outcome measure was non-operative time, with daily caseload and cancellations amongst secondary outcome measures.Results. 251 procedures were included over 58 working days Conclusion. In conclusion, additional attending anaesthesiologist hours combined with work practice changes did not impact on measures of theatre throughput and capacity. The study identified important variables that contribute to avoidable delays, and points the way for future research.

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A surgeon-led model to improve operating theatre change-over time and overall efficiency: A randomised controlled trial

Abstract: This study demonstrates a statistically significant improvement in median change-over times using this model. This re-design can be implemented without incurring extra costs, staff, or operating theatres.

Cited by 28 publications

References 12 publications

Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation

Airway Surgery Communication Protocol: A Quality Initiative for Safe Performance of Jet Ventilation

The impact of benchmarking operating room efficiency within the Veterans Health Administration

An evaluation of operating room throughput in a stand-alone soft-tissue trauma operating theatre

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