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Interdisciplinary work flow assessment and redesign decreases operating room turnover time and allows for additional caseload.

Cendán JC, Good M

Departments of Surgery and Anesthesiology, College of Medicine, and J. Hillis Miller Health Center, University of Florida, PO Box 100286, Gainesville, FL 32610-0286, USA. cendajc@surgery.ufl.edu

HYPOTHESIS: Operating room turnover time (TOT) and daily caseload can be improved by analyzing the routine tasks of the operating team and minimizing inefficiencies. DESIGN: In this prospective study, the assigned tasks and work flow patterns of the anesthesiologist, circulating nurse, and surgical technologist during operations and operating room turnover were studied and changes were implemented where inefficiencies were observed. A brief pilot followed by a broader-scale study was conducted. SETTING: Tertiary care center. PARTICIPANTS: Circulating nurses and surgical technicians were routinely assigned to work with one anesthesiologist and one surgeon during the pilot study; 4 surgeons and 32 anesthesiologists participated in the follow-up study. INTERVENTIONS: The work flow diagram of each individual was redrawn, and changes were implemented. Critical moments were identified, in which brief assistance from other personnel was needed to improve efficiency. MAIN OUTCOME MEASURES: Operative TOT and number of daily operations were the main outcomes. A 2-tailed t test was used to compare the TOTs; chi(2) analysis was used to compare the number of cases completed. Significance was defined as P<.05. RESULTS: A total of 401 operations and 253 turnovers were evaluated. Redesign decreased operating room TOT from 43.7 to 27.7 minutes (P<.001). The mean number of cases completed per day increased from 1.78 to 2.34 (P<.001). CONCLUSION: Interdisciplinary work flow assessment and redesign resulted in decreased operating room TOTs and additional cases being completed each day for 4 different surgeons.

Published 17 January 2006 in Arch Surg, 141(1): 65-9; discussion 70.
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