SUCCESSFUL STRATEGIES FOR IMPROVING OPERATING-ROOM EFFICIENCY AT ACADEMIC-INSTITUTIONS

In this prospective study, we evaluated the etiology of operating room (OR) delays in an academic institution, examined the impact of multid isciplinary strategies to improve OR efficiency, and established OR ti ming benchmarks for use in future OR efficiency studies. OR times and delay etiologies were collected for 94 cases during the initial phase of the study. Timing data and delay etiologies were analyzed, and 2 wk of multidisciplinary OR efficiency awareness education was conducted for the nursing, surgical, and anesthesia staff. After the education p eriod, timing data were collected from 1787 cases, and monthly reports Listing individual case delays and timing data were sent to the Chief s of Service. For the first case of the day, patient in room, anesthes ia ready, surgical preparation start, and procedure start time were si gnificantly earlier (P < 0.01) in the posteducation period compared wi th the preeducation period, and the procedure start time for the first case of the day occurred, on average, 22 min earlier than all other p rocedures. For all cases combined, turnover time decreased, on average , by 16 min. Unavailability of surgeons, anesthesiologists, and reside nts decreased significantly (P < 0.05) as causes of OR delays. Anesthe sia induction times were consistently longer for the vascular and card iothoracic services, whereas surgical preparation time was increased f or the neurosurgical and orthopedic services (P < 0.05). identificatio n of the etiology of OR inefficiency, combined with multidisciplinary awareness training and personal accountability, can improve OR efficie ncy. The time savings realized are probably most cost-effective when c ombined with more flexible OR staffing and improved OR scheduling. Imp lications: We achieved significant improvements in operating room effi ciency by analyzing operating room data on causes of delays, devising strategies for minimizing the most common delays, and subsequently mea suring delay data. Personal accountability, streamlining of procedures , interdisciplinary team work, and accurate data collection were all i mportant contributors to improved efficiency.