Keys to surgical efficiency in the OR: radical time transparency, reproducible procedures and outstanding teamwork

Healthcare facilities operate on very slim margins. This makes maximizing the efficiency of operating rooms (ORs) a high priority for hospitals and ASCs. Streamlining the patient journey is essential, since impediments to efficiency exist at every step along the way.

During an October podcast hosted by Becker's Healthcare, sponsored by DePuy Synthes, the Orthopedics Company of Johnson & Johnson, Charles DeCook, MD, orthopedic surgeon and president of Total Joint Specialists in Atlanta, discussed the biggest inefficiencies in ORs today and how technology and workflow changes can address them.

Five key takeaways were:

  1. Hospitals and ASCs must reexamine turnover time. Many organizations evaluate turnover time by focusing on "in the room to out of the room" times. Dr. DeCook believes this is the wrong approach. "Our definition of turnover time is from wound close to incision on the next case. That's a huge opportunity area. Lost time in the operating room usually occurs between the time the patient enters the room to when the surgeon picks up a scalpel and starts the procedure. On average, that time can be anywhere from 27 to 45 minutes," Dr. DeCook said.

  1. Radical time transparency is the key to optimizing surgical efficiency. Surgeons need to understand where OR time is spent and where time is lost. "Many applications put time front and center in the operating room," Dr. DeCook said. "That provides data to enact change. If you aren't constantly evaluating the time you are gaining or losing, you will never effect change."

  1. Reproducibility reduces OR time and leads to better patient outcomes. When surgeons are dedicated to excellence, they strive to perform the same cases in a reproducible way. "A natural result of that process improvement work is that OR time goes down and teams become aligned," Dr. DeCook said. "As you get better at your craft, you eliminate unnecessary steps and inefficiencies, which is better for patients. When OR time decreases, patients have a lower risk of infections, deep vein thrombosis and other complications. In addition, mortality and readmission rates go down."

  1. Teams must be in complete command of the patient journey. To minimize waiting time for patients, surgical teams must deliver people to the waiting room at the right time. When teams have full visibility into the patient journey, they can also optimize the surgeons' time. "Another source of inefficiency arises when surgeons are ahead of schedule and they have to wait for patients. We never allow that to happen. Our whole team is aware of where we are in the patient journey. If I'm ahead of schedule, the team automatically calls the next patient and brings them in early," Dr. DeCook said.

  1. Magic happens when OR teams work together on a regular basis. Based on his experience, Dr. DeCook believes that surgical teams work effectively if they work together all the time. In addition, Total Joint Specialists has created dedicated teams for the OR, pre-op and PACU. This structure means that more staff members are available to help at critical moments during patient turnover. "On a total joint, it can take 15 to 30 minutes to open trays and get ready. If you can bring in more resources to help at times like this, it enables the scrub techs to concentrate on the patient," Dr. DeCook said.

Listen to the podcast here.

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