What affects operating room turnover time? A systematic review and mapping of the evidence

The operating room environment is a complex system associated with high operating costs and requires careful management to optimize patient outcomes and productivity. One of the most studied metrics of operating room efficiency is turnover time. This study systematically reviews mutable factors associated with improvements in operating room turnover time.

In accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we identified observational and interventional approaches analyzing an association between a mutable factor and operating room turnover time (defined as the time between closure and next incision on the subsequent patient). We defined mutable factors as any generalizable element of the operating room environment amenable to change with intervention. Each study was categorized by the type of mutable factor and specific phase of turnover time affected.

Of 1,507 studies identified, 551 underwent abstract review with 105 meeting eligibility for this systematic review. There were 136 unique analyses of a relationship between a mutable factor and operating room turnover time. The mutable factors analyzed in these studies varied widely, including changes in anesthetic approach, communication/goal setting, allied health staff, artificial intelligence/information technology, operating room management, setup standardization, prearrival optimization, and operating room type. The analyzed literature showed the potential for mutable factors in each of these domains to improve operating room efficiency by reducing turnover time.

Operating room efficiency is critical to the financial health and success of a hospital. This review organizes a large body of information relating to turnover time with an approach that can guide scientists and leaders interested in operating room efficiency. The most impactful areas discovered were related to parallel processing, team dynamics, and a "focused factory" approach.