In some large, academic hospitals, busy surgeons often request the concurrent use of multiple operating rooms (ORs), with the goal of increasing efficiency.
In the past, the practice has been associated with increased patient time in the OR, but little if any research to date has studied the issue formally. Timothy Harwood, MD, director of quality improvement at Wake Forest Baptist Medical Center and associate professor of anesthesiology at Wake Forest University School of Medicine, in Winston-Salem, N.C., sought to change that with a study that he presented at Euroanaesthesia 2015, the annual congress of the European Society of Anaesthesiology (abstract 16AP3-6).
For his study, Dr. Harwood imported the raw surgical log data for a two-year period from his hospital’s electronic health record system into Excel, and calculated the times all patients spent in the inpatient, pediatric and outpatient ORs. He then categorized cases based on procedure type and individual surgeon involved. Cases were further divided into “cases in which the surgeon was in one OR the entire time,” and “cases in which the surgeon was allowed to operate in more than one OR during scheduled procedures.”
Dr. Harwood analyzed results for the 50 most common surgical procedures performed at his hospital. He found that concurrent OR scheduling resulted in shorter average patient OR times in 27 of the 50 most common surgical procedures, and that 13 of the procedure types had statistically significant differences in OR times (seven had shorter times and six had longer times).
“This examination of our OR data helped us determine what proportion of cases would entail longer OR times if the attending surgeon was overseeing cases in two ORs,” Dr. Harwood said. “However, the details of the subgroups were more helpful. We were able to determine which specific surgeons and specific procedures reliably resulted in shorter OR times when the surgeon was covering two ORs.”
Studies such as this one speak to recent efforts by anesthesiologists to increase their management role in the OR, as evidenced by initiatives such as the American Society of Anesthesiologists’ perioperative surgical home. “Surgeons need to focus on their particular patients and procedures,” Dr. Harwood said. “Anesthesiologists have the ability to integrate data analysis with clinical OR management in an effort to produce more efficient and safe care.”
However, not all surgeons believe that concurrent ORs are the best way to achieve that. Frederick L. Greene, MD, clinical professor of surgery at the University of North Carolina School of Medicine, in Chapel Hill, and medical director of Cancer Data Registry at Levine Cancer Institute, in Charlotte, N.C., said, “I’m not a great fan of surgeons having more than one operating room going. I never have been. Now it’s true that at large, academic hospitals, where there are senior residents and fellows who are trained to initiate cases in the OR with readily available anesthesia and nursing personnel, it can work. But at small, local hospitals, it’s simply not feasible to have concurrent ORs.”
Indeed, Dr. Greene believed that future research efforts on OR efficiency should focus on the issue of turnover time, which he said is a significant problem at all hospitals. “That’s an area where anesthesiology definitely has a role, in terms of implementing strategies to move patients from the OR into recovery faster, so that staff can clean and prep the OR for the next procedure,” he added. “We all want the OR to operate efficiently, and that takes surgeons and anesthesiologists working together.”
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