Surgical pit crew: initiative to optimise measurement and accountability for operating room turnover time.

IF 4.1 Q1 HEALTH CARE SCIENCES & SERVICES BMJ Health & Care Informatics Pub Date : 2023-07-01 DOI:10.1136/bmjhci-2023-100741
Nicole H Goldhaber, Robin L Schaefer, Roman Martinez, Andrew Graham, Elizabeth Malachowski, Lisa P Rhodes, Ruth S Waterman, Kristin L Mekeel, Brian J Clay, Michael McHale
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Abstract

Background and objectives: Turnover time (TOT), defined as the time between surgical cases in the same operating room (OR), is often perceived to be lengthy without clear cause. With the aim of optimising and standardising OR turnover processes and decreasing TOT, we developed an innovative and staff-interactive TOT measurement method.

Methods: We divided TOT into task-based segments and created buttons on the electronic health record (EHR) default prelogin screen for appropriate staff workflows to collect more granular data. We created submeasures, including 'clean-up start', 'clean-up complete', 'set-up start' and 'room ready for patient', to calculate environmental services (EVS) response time, EVS cleaning time, room set-up response time, room set-up time and time to room accordingly.

Results: Since developing and implementing these workflows, measures have demonstrated excellent staff adoption. Median times of EVS response and cleaning have decreased significantly at our main hospital ORs and ambulatory surgery centre.

Conclusion: OR delays are costly to hospital systems. TOT, in particular, has been recognised as a potential dissatisfier and cause of delay in the perioperative environment. Viewing TOT as one finite entity and not a series of necessary tasks by a variety of team members limits the possibility of critical assessment and improvement. By dividing the measurement of TOT into respective segments necessary to transition the room at the completion of one case to the onset of another, valuable insight was gained into the causes associated with turnover delays, which increased awareness and improved accountability of staff members to complete assigned tasks efficiently.

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外科工作人员:主动优化手术室周转时间的测量和责任。
背景和目的:周转时间(TOT),定义为同一手术室(OR)手术病例之间的时间,通常被认为是长而没有明确的原因。为了优化和标准化OR周转流程并减少TOT,我们开发了一种创新的员工互动TOT测量方法。方法:我们将TOT划分为基于任务的部分,并在电子健康记录(EHR)默认预登录屏幕上为适当的员工工作流创建按钮,以收集更细粒度的数据。我们创建了包括“清理开始”、“清理完成”、“设置开始”和“为患者准备房间”在内的子措施,以计算环境服务(EVS)响应时间、EVS清洁时间、房间设置响应时间、房间设置时间和到房间的时间。结果:自从开发和实施这些工作流程以来,度量已经证明了优秀的员工采用。在我们的主要医院手术室和门诊手术中心,EVS反应和清洁的中位数时间显著减少。结论:手术室延误对医院系统来说代价高昂。特别是TOT,已被认为是一个潜在的不满意因素,并导致围手术期环境的延迟。将TOT视为一个有限的实体,而不是由各种团队成员完成的一系列必要任务,限制了关键评估和改进的可能性。通过将TOT的测量划分为在一个案例完成时将房间过渡到另一个案例开始时所必需的各个部分,可以获得与离职延迟相关的原因的宝贵见解,从而提高了工作人员的认识并改进了问责制,以有效地完成分配的任务。
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来源期刊
CiteScore
6.10
自引率
4.90%
发文量
40
审稿时长
18 weeks
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