Reducing Wasted Time Prior To Starting Thoracic Surgical Operations.

Area of Science:

• Surgical Process Improvement
• Operating Room Efficiency
• Thoracic Surgery

Background:

• The interval between operating room entry and skin incision in thoracic surgery can be lengthy.
• Optimizing pre-incision workflows is crucial for improving operating room turnover and patient safety.

Purpose of the Study:

• To design and implement multidisciplinary interventions to decrease the pre-incision time in thoracic surgical operations.
• To assess the impact of standardized procedures on surgical workflow efficiency.

Main Methods:

• A multidisciplinary team identified 38 pre-incision steps.
• Critical path and Pareto analysis informed intervention design, focusing on intubation, patient positioning, and line placement.
• Pre-incision times were measured across four phases: pre-intervention, run-in, post-intervention, and a five-month follow-up.

Main Results:

• The median pre-incision time decreased by 19%, from 42.5 minutes to 34.5 minutes, with sustained improvement at follow-up (33 minutes).
• Median positioning time was reduced from 9 to 4 minutes, and intubation time decreased from 7.5 to 6 minutes.
• Reductions in pre-incision times were maintained five months post-intervention.

Conclusions:

• Multidisciplinary team engagement in designing process improvements effectively reduces pre-incision time in thoracic surgery.
• Standardization of key steps and reduction of process variability are key to achieving and sustaining operating room efficiency.