Can A Foot And Ankle Surgery Coordinator Improve OR Efficiency?

Examining study data, this author highlights the role of a foot and ankle surgery coordinator and the positive impact the position has on efficiency measures in the operating room.

The operative day at the hospital can be a frustratingly slow and inefficient endeavor for both patient and surgeon alike. Delays, case cancellations and missing implant trays can add to this frustration. For the hospital, surgeon and anesthesia team, inefficient use of operating room (OR) time means a loss of revenue and increased overhead. 

The Foot and Ankle Center of Excellence at Dublin Methodist Hospital in Dublin, Ohio has a proactive system in place to measure, monitor and constantly improve the foot and ankle OR efficiency in a hospital setting. Key to this initiative is the use of a full-time foot and ankle surgery coordinator who oversees this program. The coordinator oversees the staffing of all foot and ankle cases, coordinates the case schedule with anesthesia coverage, attends and participates in weekly case previews for implant needs, and is on site in the OR to facilitate timely turnover and OR throughput.

Over a six-month period with the foot and ankle surgery coordinator in place, we prospectively tracked internal chart data related to first case delays, operating room turnover times and requested equipment pull for assigned procedures. We also tracked case cancellations due to inadequate chart review or lack of equipment for the case in question. We previewed each surgery in a radiology conference with the primary surgeon to determine equipment needs and requests. All cases had pre-op regional nerve blocks. There was adequate staffing to facilitate turnover and case cart checks. In addition, there was an operative case whiteboard in each OR with appropriate patient positioning and equipment needs to inform the room staff.

Over the six-month period, there were 653 foot and ankle surgeries in this hospital setting. There were no same day cancellations due to charting or equipment errors. First case start times had an on-time start rate of 100 percent. Appropriate equipment pull for assigned cases was 100 percent and OR turnover was an average of 13.5 minutes.

In Conclusion

Efficient use of expensive OR and surgeon time resources is the key to providing quality delivery of healthcare. Key measures include on-time first case starts, a lack of same day cancellations and a high rate of requested equipment pulled for each case.

The use and leadership of a full time foot and ankle surgery coordinator in a hospital OR setting has a strong positive impact on all efficiency measures we tracked in this pilot study. Innovative methods include a prospective weekly case preview, an whiteboard in the OR for case communication to room staff and an on-site foot and ankle surgery coordinator to facilitate daily OR operation.

Additional comparative studies against centers without a dedicated coordinator are needed and are in the planning stages.

Dustin Walker, RN is the Clinical Operating Room Manager at Polaris Surgery Center in Westerville, OH, and was previously the OR Coordinator for foot and ankle at OhioHealth Dublin Methodist Hospital.

Dr. Hyer is a Fellow of the American College of Foot and Ankle Surgeons, and serves on its Board of Directors. He is the Fellowship Director and an attending physician at the Orthopedic Foot and Ankle Center in Westerville, Ohio.