Improving Efficiency in the OR
Healthcare environments are constantly growing and changing, which means the demand for efficiency is increasing every day. Hospitals strive for high-quality care for the lowest cost, but how does the activity behind operating room doors affect these demands?
Efficient strategies throughout the perioperative period are written about and discussed often, however, the intraoperative period gets less attention. The intraoperative period is when the patient is in the operating room – the primary OR experience and the basis for procedure billing. Since the majority of surgical dollars are spent during this time, efficiency is key to eliminate the opportunity for the hospital to lose money. Because surgeons are performing each procedure, they are in the ideal position to make sure any efficiency improvements do not threaten the integrity of care.
These efforts are quick fixes and only involve a strong department leader to initiate.
1. Instrument Standardization
Standardizing supplies and durable instruments to only those needed during a procedure reduces operative costs, setup time, counting time, excess clutter, reprocessing costs and turnover time of supplies. An author who wrote about this small-scale intervention applied lean methodology to reduce surgical trays for a minimally invasive spinal surgery by 70%, which in turn decreased the operation time by seven minutes.
2. Team Huddles
Team huddles are a helpful initiative before and after procedures to allow surgeons to review OR plans, goals, and anticipated flow. 11 surgeons at Johns Hopkins University used this strategy to decrease unexpected OR delays from 36% to 25% in about 400 cases.
Medium-scale interventions require a whole OR floor or group of people to see benefits.
3. Checklist Utilization
Checklists in ORs today tend to focus on immediate pre and post procedural checks, but extending them throughout each operation is important. For general surgical procedures, observer-administered checklists keep track of the completion of key efficiency-related OR tasks during each stage of surgery.
4. Fixed Teams
Fixed teams increase case productivity because nurses have a familiarity with the tools, knowledge of surgeon preferences, and the ability to anticipate needs. When staff is paired up with new colleagues on a regular basis, consistency is compromised and a learning curve must be accounted for. One author examined 754 cases of bilateral reduction mammoplasty procedures and found that surgical team familiarity accounted for a 16 minute reduction in operative time after 10 collaborations.
These endeavors require institutional cooperation as well as a hefty time and financial investment.
5. Supply Chain Management
This is crucial in order to reduce costs and increase efficiency because hospitals spend around 50% of OR budgets on supplies. Ensuring the right tools are available and the unnecessary ones remain unopened has great potential to reduce delays, decrease labor costs to restock unused items, and improve the staff’s focus on patient care. Radiofrequency identification (RFID) tracks supplies with barcodes to boost speed and accuracy, while collecting meaningful data by linking supplies to specific patients.
Specialization is only justifiable at medical centers with high enough volume, but have the capability to greatly improve time and cost savings. Personnel, programs, instruments and ORs can all be specialized. One author examined the effect of a specialized traumatologist for surgical fracture care compared to a general orthopedic surgeon. In the 2,076 cases studied, the traumatologist’s procedures were about 20 minutes shorter.
The need for increased efficiency in the health system differs based on size and resources, but overall, data transparency, communication, and quality patient care are the most critical components to intraoperative period enhancements.