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Improving Operating Room Turnover Time: A Systems Based Approach

  • Systems-Level Quality Improvement
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

Abstract

Operating room (OR) turnover time (TT) has a broad and significant impact on hospital administrators, providers, staff and patients. Our objective was to identify current problems in TT management and implement a consistent, reproducible process to reduce average TT and process variability. Initial observations of TT were made to document the existing process at a 511 bed, 24 OR, academic medical center. Three control groups, including one consisting of Orthopedic and Vascular Surgery, were used to limit potential confounders such as case acuity/duration and equipment needs. A redesigned process based on observed issues, focusing on a horizontally structured, systems-based approach has three major interventions: developing consistent criteria for OR readiness, utilizing parallel processing for patient and room readiness, and enhancing perioperative communication. Process redesign was implemented in Orthopedics and Vascular Surgery. Comparisons of mean and standard deviation of TT were made using an independent 2-tailed t-test. Using all surgical specialties as controls (n = 237), mean TT (hh:mm:ss) was reduced by 0:20:48 min (95 % CI, 0:10:46–0:30:50), from 0:44:23 to 0:23:25, a 46.9 % reduction. Standard deviation of TT was reduced by 0:10:32 min, from 0:16:24 to 0:05:52 and frequency of TT≥30 min was reduced from 72.5to 11.7 %. P < 0.001 for each. Using Vascular and Orthopedic surgical specialties as controls (n = 13), mean TT was reduced by 0:15:16 min (95 % CI, 0:07:18–0:23:14), from 0:38:51 to 0:23:35, a 39.4 % reduction. Standard deviation of TT reduced by 0:08:47, from 0:14:39 to 0:05:52 and frequency of TT≥30 min reduced from 69.2 to 11.7 %. P < 0.001 for each. Reductions in mean TT present major efficiency, quality improvement, and cost-reduction opportunities. An OR redesign process focusing on parallel processing and enhanced communication resulted in greater than 35 % reduction in TT. A systems-based focus should drive OR TT design.

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Abbreviations

ACGME:

Accreditation council for graduate medical education

CI:

Confidence interval

CRNA:

Certified registered nurse anesthetist

CTO:

Call-to-order

EUHM:

Emory University Hospital Midtown

FTE:

Full time equivalent

H&P:

History & physical

hh:mm:ss:

Hours:minutes:seconds

NPV:

Net present value

OR:

Operating room

PACU:

Post-anesthesia care unit

TT:

Turnover time (Wheels Out → Wheels In)

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Acknowledgments

The authors would like to recognize members of the operating room team at the Emory University Hospital Midtown for their support in this initiative.

Ankeet S. Bhatt was supported for summer 2012 by a fellowship from The Emory Clinic, an entity of Emory Healthcare, Woodruff Health Sciences Center, Emory University, Atlanta, GA 30322. Sponsors or funders were not involved in any process of this study including but not limited to: design, collection, analysis, or interpretation of data, or preparation, review, or approval of this manuscript.

Ankeet S. Bhatt and Peter J. Deckers had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Author disclosure information

Nothing to disclose.

Author contributions

Study conception and design: Bhatt, Carlson, Deckers

Acquisition of data: Bhatt, Carlson

Analysis and interpretation of data: Bhatt, Carlson, Deckers

Drafting of manuscript: Bhatt, Carlson, Deckers

Critical revision: Bhatt, Deckers

Author information

Authors and Affiliations

  1. University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06032, USA

    Ankeet S. Bhatt & Peter J. Deckers

  2. University of Connecticut School of Business, Storrs, CT, 06269, USA

    Ankeet S. Bhatt

  3. Emory University School of Medicine, Atlanta, GA, 30322, USA

    Grant W. Carlson

Authors
  1. Ankeet S. Bhatt
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  2. Grant W. Carlson
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  3. Peter J. Deckers
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Corresponding author

Correspondence to Ankeet S. Bhatt.

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This article is part of the Topical Collection on Systems-Level Quality Improvement

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Bhatt, A.S., Carlson, G.W. & Deckers, P.J. Improving Operating Room Turnover Time: A Systems Based Approach. J Med Syst 38, 148 (2014). https://doi.org/10.1007/s10916-014-0148-4

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  • DOI: https://doi.org/10.1007/s10916-014-0148-4

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