Healthcare environments are continually growing and changing, which means the demand for efficiency is increasing every day. Hospitals strive for high-quality care for the lowest cost, but how does the activity behind the operating room doors affect these demands?

Improvement strategies for the perioperative period are frequently discussed; however, evaluation of the intraoperative period gets less attention. The intraoperative period is when the patient is in the operating room and is the basis for procedure billing. Since the majority of surgical dollars get spent during this time, efficiency is critical to eliminate the opportunity for the hospital to lose money. Because surgeons are performing each procedure, they are in the ideal position to make sure any efficiency improvements do not threaten the integrity of care.

SMALL-SCALE INTERVENTIONS

We have outlined a few quick fixes that only involve a strong department leader to initiate to help make an immediate impact on operating room efficiency:

• INSTRUMENT STANDARDIZATION. Standardizing supplies and durable instruments to only those needed during a procedure reduces operative costs, setup time, counting time, excess clutter, reprocessing fees, and turnover time of supplies. An author who wrote about this small-scale intervention applied Six Sigma LEAN® methodology to reduce surgical trays for a minimally invasive spinal surgery by 70%, which in turn decreased the operation time by seven minutes.
• TEAM HUDDLES. Team huddles are a valuable initiative before and after procedures to allow surgeons to review OR plans, goals, and anticipated flow. Eleven surgeons at Johns Hopkins University used this strategy to decrease unexpected OR delays from 36% to 25% in about 400 cases.

MEDIUM-SCALE INTERVENTIONS

Medium-scale interventions require a whole OR floor or group of people to see benefits.

• CHECKLIST UTILIZATION. Checklists in ORs today tend to focus on immediate pre and post-procedural checks, but extending them throughout each operation is essential. For general surgical procedures, observer-administered lists keep track of the completion of critical efficiency-related OR tasks during each stage of surgery.
• FIXED TEAMS. Fixed teams increase case productivity because nurses have a familiarity with the tools, knowledge of surgeon preferences, and the ability to anticipate needs. When staff is paired up with new colleagues regularly, consistency is compromised, and a time for a learning curve must be in place. One author examined 754 cases of bilateral reduction mammoplasty procedures and found that surgical team familiarity accounted for a 16-minute reduction in operative time after ten collaborations.

LARGE-SCALE INTERVENTIONS

These endeavors require institutional cooperation as well as a hefty time and financial investment.

• SUPPLY CHAIN MANAGEMENT. Supply Chain Management is crucial to reduce costs and increase efficiency because hospitals spend around 50% of OR budgets on supplies. Ensuring the right tools are available and the unnecessary ones remain unopened has excellent potential to reduce delays, decrease labor costs to restock unused items, and improve the staff’s focus on patient care. Radiofrequency identification (RFID) tracks supplies with barcodes to boost speed and accuracy while collecting meaningful data by linking supplies to specific patients.
• SPECIALIZATION. Specialization is only justifiable at medical centers with high enough volume, but can significantly improve time and cost savings. Personnel, programs, instruments, and ORs can all be specialized. One author examined the effect of a specialized traumatologist for surgical fracture care compared to a general orthopedic surgeon. In the 2,076 cases studied, the traumatologist’s procedures were about 20 minutes shorter.

The need for increased efficiency in the health system differs based on size and resources, but overall, data transparency, communication, and quality patient care are the most critical components to intraoperative period enhancements.