Preparatory Time-Related Hand Surgery Operating Room Inefficiency: A Systems Analysis

Area of Science:

• Orthopedics
• Surgical Operations
• Quality Improvement

Background:

• Operating room inefficiency is a persistent challenge in surgical settings.
• Preparatory time, defined as the interval from patient entry to skin incision, has not been previously studied in relation to hand surgery operating room efficiency.
• Understanding and optimizing preparatory time is crucial for improving surgical workflow and resource utilization.

Purpose of the Study:

• To investigate the duration and variability of preparatory time in hand surgery.
• To assess the relationship between preparatory time and various factors such as surgical site, surgeon, case type, and anesthesia.
• To identify preparatory time as a potential source of operating room inefficiency.

Main Methods:

• A retrospective review of consecutive upper extremity cases performed by hand surgeons across three surgical sites was conducted.
• Preparatory time was measured and compared across different locations.
• Statistical methods and Shewhart control charts were employed to analyze data and assess process variability.

Main Results:

• A total of 288 cases were analyzed, with average preparatory times ranging from 20.7 to 25.7 minutes across sites.
• Preparatory time constituted 34% of total operating room time and was 75% the duration of surgical procedures.
• Control charts revealed significant variability in preparatory time, indicating a poorly defined process. No significant differences were found based on case type or ASA status, but variability existed between surgeons and anesthesia types.

Conclusions:

• Preparatory time represents a substantial and independent source of inefficiency in hand surgery operating rooms.
• Significant variability, confirmed by control charts, highlights a poorly designed process that warrants optimization.
• Surgeon-specific factors and anesthesia type appear to influence preparatory time, suggesting targeted interventions may improve operating room workflow.