A presentation based on a study from Cleveland Medical Center is posted here. The study focused on the impact of in-room to incision time and closure to out-of-room time on OR throughput. The point was made that these two components have a significant impact on overall OR efficiency but are often given less attention than turnover time. Investigators analyzed data from 11,497 cases involving multiple specialties. Significant discussion surrounded in-room to skin incision for General Surgeons, who performed about 40% of the cases at an average for this measure of 38 minutes, close to the 36.6-minute average in-room to incision for the entire surgical volume studied. For General Surgeons this represented 20% of the total OR time, while close to exiting the OR was 14 minutes or only 7% of total OR time. The study found substantial variability between general surgeons for in-room to incision time, ranging from 11 to 51 minutes, and found no statistically significant difference between surgical subspecialties in this metric. Key team attributes reducing the time to incision included the presence of the surgeon in the OR, checking of equipment prior to room entry, prep/drape on induction and incision on intubation. Similar issues drove high performance for close to out-of-OR. In both, the presence of the surgeon was an important factor.
EHC NOTE: For us there are several key takeaways from this study: 1) surgeon engagement throughout the OR time period (wheel in to wheels out) helps drive performance, 2) the throughput components in focus in this study (wheels-in to incision and close to wheels-out) receive scant attention in many OR’s yet have a significant impact on performance and 3) parallel processing is a way to meaningfully reduce components of OR throughput. Any of the facilities we have worked with on perioperative improvement initiatives have heard us reiterate these points conceptually and have worked with us to measure their absolute and relative performance. We recommend OR leadership teams review the key points from the study referenced and work with surgeons, anesthesia providers and nurses to incorporate these concepts into their facilities.