Using a Fixed OR Team to Perform Consecutive Similar Surgeries

Efficient use of surgical resources includes effective scheduling of procedures, but surgical scheduling is complicated by variation and uncertainty in procedure times. According to researchers, if variation in procedure time could be controlled or better predicted, improved scheduling could reduce the cost of surgeries. The standard personnel for an operating room (OR) include a surgeon (with or without an assisting surgical resident), a surgical nurse, anesthesiologist, nurse circulator, and nurse providing anesthesia. In many hospitals, particularly teaching hospitals, personnel are often switched across various ORs during the day; the switch may also be across procedure type and OR team. Some staff members felt they needed adaptation/familiarization time at the beginning of or during a surgical procedure. Researchers based at St. Franciscus Hospital in Rotterdam, the Netherlands, recently conducted a case-control study to assess the benefits of a fixed team working on similar consecutive cases during the day in the same OR. The study was designed to test the hypothesis that this concept would reduce the adaptation/familiarization time for a specific procedure, and consequently reduce the OR time. Study results were reported in Archives of Surgery [2010;145(12):1165-1170]. Patients were randomly assigned to the study or the control group. During the study, if a patient was scheduled for 1 of the 2 procedures on a Friday in the odd weeks of the month, the patient was part of the study group. If the surgical procedure was scheduled for a Friday in the even weeks, the patient was in the control group. For the hernia repair procedure, there were 68 patients on 17 study days and 68 patients on 17 control days. There were 68 different teams on control days. For the hernia repair surgery, mean preparation, surgical, and procedure times were lower in the study group compared with the control group: 6.8 minutes versus 15.2 minutes, 48.0 minutes versus 51.2 minutes, and 59.8 minutes versus 71.2 minutes, respectively. For the cholecystectomy, the mean times for the study group compared with the control group were 22.2 minutes versus 25.5 minutes, 82.8 minutes versus 88.1 minutes, and 117.7 minutes versus 123.0 minutes for preparation time, surgical time, and procedure time, respectively. The difference in surgical time was not significant for the cholecystectomy, a more complex procedure than the hernia repair. In summary, the researchers said, “scheduling similar consecutive cases and performing with a fixed team results in lower turnover times and preparation times. The surgical time of the inguinal hernia repair decreased significantly and has practical scheduling implications. For more complex surgery, like laparoscopic cholecystectomy, there is no effect on surgery time.”