Separate rooms for patient induction, case set-up and breakdown: Innovative operating room turnover through quality management

Abstract

Turnover time (TT) is the time it takes to prepare an operating room (OR) between consecutive surgeries. Short TT improves OR efficiency, while maintaining patient and staff safety and satisfaction. Yet the multitude of staff involved and steps required creates process complexity that can hinder this goal. Leveraging a unique case study setting, this study deploys a collection of quality management tools to investigate how the use of separate support rooms for patient induction (the administration of anesthesia), case set-up, and case breakdown can reduce OR TT while maintaining safety and satisfaction. Key results show that separate rooms for patient induction and case breakdown can enable parallel processing, improve patient and staff safety, and patient experience. We use post implementation observations to measure TT reduction when using an induction room, which allows time for an extra case per day. We develop decision-support models practitioners can use to identify the potential benefits of separate support rooms during the OR turnover, based on operating conditions and surgical characteristics. We provide considerations from buffer theory and coordination theory for the separation of physical space, proposing a novel view of the OR turnover process as a set of service modules and interfaces.

Keywords:

• focus group interviews
• high-fidelity mockup simulations
• interrelationship diagram
• operating room turnover
• perioperative services

Acknowledgments

The authors are grateful for the participation of the entire RIPCHD.OR research team to some discussions throughout this project, and for the participation of undergraduate and graduate students at various points during this project. In particular, we are grateful for the assistance of Marissa Shehan, Seyed Amin Seyed Haeri, Herminia Machry, and Deborah Wingler for some data collection and reporting. The authors are grateful for the constructive feedback and suggestions of the review team, which contributed to improving the quality of the manuscript and the clarity of the presentation of the findings.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This research was funded through the Agency for Healthcare Research Quality (AHRQ), grant number P30HS0O24380 2015, titled “RIPCHD.OR (Realizing Improved Patient Care through Human-Centered Design in the Operating Room),” Principal Investigators: Anjali Joseph (PhD, EDAC), Clemson University, and Scott T. Reeves (MD, MBA, FACC, FASE), the Medical University of South Carolina (MUSC).

Notes on contributors

Yann B. Ferrand

Yann B. Ferrand, PhD, is an Assistant Professor of operations management in the Hull College of Business at Augusta University. His primary research interests are in providing innovative solutions in healthcare delivery services through better scheduling and resource allocation, handling uncertainty and variability using optimization and simulation methodologies. His research has been published in Journal of Operations Management, Decision Science Journal, INFORMS Journal on Applied Analytics, Quality Management Journal, Health Care Management Science, and Annals of Emergency Medicine, among others.

Lawrence D. Fredendall

Lawrence D. Fredendall, PhD, joined Clemson University, Department of Management, received a PhD from Michigan State University in 1991. Since then he has taught Undergraduate, Masters and PhD level supply chain management courses. His research interest is achieving sustainable enterprises through continuous improvement and lean methods. He has published 76 refereed articles, and three books. Lawrence has been an associate editor at the Journal of Operations Management since 2014. He is a past Editor of the Quality Management Journal, from 2013 to 2016. He was a Special Issue Co-Editor for the Journal of Operations Management Special Issue on Healthcare Delivery. He was also a past Vice-President for Awards for the College of Healthcare Operations Management (CHOM) at Production Operations Management Society.

Kevin Taaffe

Kevin Taaffe, PhD, is the Harriet and Jerry Dempsey Professor, and Interim Department Chair of the Department of Industrial Engineering at Clemson University. His main areas of research are production and inventory management, transportation and logistics analysis, healthcare systems engineering, application of optimization and simulation modeling tools. Most recently, he has published in International Transactions of Operational Research, Journal of Operations Management, and Health Systems, among others.

Dee San

Dee San, MBA, BSN, RN, CSSBB, is President at San Solutions Services, and was Perioperative Quality and Safety Manager at the Medical University of South Carolina (MUSC). She has extensive experience in project management, leading large academic medical center departments, overseeing national and international healthcare consulting engagements, developing effective Quality and Performance Improvement Programs (QAPI), contributing to scientific research. She is Lean Six Sigma Black Belt and Just Culture certified.

Jaeyoung Kim

Jaeyoung Kim, MS, was a PhD candidate in the Management Department and is now an Assistant Professor in the School of Business Administration at the University of Dayton. Her research interests lie at the intersection of healthcare operations, behavioral operations, and data-driven decision-making using empirical analysis and data analytics.

Anjali Joseph

Anjali Joseph, PhD, is Professor of Architecture and Industrial Engineering and Spartanburg Regional Healthcare System Endowed Chair in Architecture + Health Design. She is also the Director of the Center for Health Facilities Design and Testing at Clemson University. Joseph has served as principal investigator on millions of dollars of grant-funded projects from the Agency for Healthcare Research and Quality (AHRQ), the Kresge Foundation, the California HealthCare Foundation and the U.S. Green Building Council. Her groundbreaking research on operating room design resulted in the development of a prototype OR, and the design concepts have been implemented in multiple ambulatory surgery centers across the U.S.

Brandon Lee

Brandon Lee, PhD, is an Assistant Professor of Operations Management and Business Analytics at the University of Dayton. His research focuses on the areas of healthcare operations management, quality and process improvement, and supply chain management. He obtained his PhD degree in Supply Chain and Operations Management from Clemson University. Prior to his PhD study, he had a 12-year career in multinational corporations including Siemens and Aisin (a Toyota Group company), where he primarily worked in the field of quality management and Six Sigma process improvement.

Alexis Fiore

Alexis Fiore, MS, was a consultant at Integrated Insight, Inc., and is now an Industrial Engineer at Walt Disney World. She earned a Master of Science in Industrial Engineering from Clemson University, where she worked on research projects with the Medical University of South Carolina (MUSC) and with Samsung.