Turnover Time in Arthroscopic Shoulder Surgery: A Reduction of 18% by 2 Simple Strategies

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Abstract

Purpose:

The aim of the study was to determine whether 3 strategies such as parallel anesthetic induction, improving first case start times, and dedicating porters to surgical theatres could reduce turnover times.

Methods:

A prospective interventional clinical study of operating room processes was conducted in a day surgery facility during arthroscopic shoulder surgery. The study included a 10-week observation period, then a 2-week education period, followed by a 10-week intervention period. Three intervention strategies were used as (1) parallel anesthetic induction, defined as performing the anesthetic induction on the next patient during the intraoperative period of the currently anesthetized patient; (2) a dedicated porter system, in which the porter completed his duties of room clean up and next patient prep before leaving the room; and (3) starting the first case within 10 minutes of scheduled start time. The major outcome was turnover time—the time between end of skin closure of the first patient to knife to skin of the next patient in the same theater. Minor outcomes included porter time (wheel out to wheel in), first case start times, and cost savings.

Results:

Intervention of the 3 strategies reduced turnover time by 9 minutes (18%), from 51±10 minutes (mean±SD) to 42±9 minutes. Porter times were reduced by 6 minutes (27%). First case start times improved by 12 minutes, although this did not affect turnover time per se. Total time savings per day was 61 minutes. The reduction in turnover time and improvement in first case start times resulted in a minimum net financial benefit of $430 per day to the day surgery facility.

Conclusions:

Parallel anesthetic induction and dedicating porters to theaters significantly decreased turnover time.

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