Improved utilization of operating room time for trainee cataract surgery in a public hospital setting

To examine the effect of group goal and group performance theories on operating room efficiency in resident-performed cataract surgery.

Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, University of California, San Francisco, California, USA.

Prospective case series.

This study assessed 4 specific segments of operating room utilization identified as room-to-incision time, incision-to-close time, close-to-exit time, and room turnover time. The time segments were measured for resident-performed cataract cases before the proposed intervention. Then, group goals were set for ideal times of each utilization segment. Behaviors of the surgery, anesthesia, nursing, pharmacy, and housekeeping teams that would improve group performance were identified. Utilization segments were measured again after the intervention.

The time segments were measured for 134 resident-performed cataract cases before the proposed intervention and again after the intervention for 136 resident-performed cataract cases. Before the intervention, the mean overall case time was 55 minutes, allowing for 10 cases in a 10-hour day. After the intervention, the mean overall case time was 46 minutes, allowing for 13 cases in a 10-hour day. The decrease in postintervention times for overall case time, room-to-incision time, and close-to-exit time were statistically significant.

Operating room utilization for resident-performed cataract surgery was enhanced by setting group goals. A multidisciplinary effort to enhance group performance through behavior modification can be implemented immediately and improve efficiency without compromising patient safety or resident teaching.