Why can’t we improve turnover time? A systematic review

• Published in: World journal of surgery Vol. 48; no. 1; pp. 72 - 85
• Main Authors: Cohen, Tara N., Kanji, Falisha F., Zamudio, Jennifer, Shouhed, Daniel, Gewertz, Bruce L., Sax, Harry C.
• Format: Journal Article
• Language: English
• Published: United States 01.01.2024
• Subjects: efficiency; Efficiency, Organizational; human factors; Humans; operating room turnover; Operating Rooms - organization & administration; process mapping; Quality Improvement; systematic review; Time Factors; Workflow; process mapping; efficiency; systematic review; human factors; operating room turnover
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1002/wjs.12015

Background Despite substantial efforts to reduce operating room (OR) turnover time (TOT), delays remain a frustration to physicians, staff, and hospital leadership. These efforts have employed many systems and human factor‐based approaches with variable results. A deeper dive into methodologies and their applicability could lead to successful and sustained change. The aim of this study was to conduct a systematic review to evaluate relevant research focused on improving OR TOT and clearly defining measures of successful intervention. Material and Methods A systematic review of OR TOT interventions implemented between 1980 through October 2022 was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methodology. Research databases included: 1) PubMed; 2) Web of Science; and 3) OVID Medline. Results A total of 38 articles were appropriate for analysis. Most employed a pre/post intervention approach (29, 76.3%), the remaining utilized a control/intervention approach. Nine intervention methods were identified: the majority included a process redesign bundle (24, 63%), followed by overlapping induction, dedicated unit/team/space feedback, financial incentives, team training, education, practice guidelines, and redefinition of roles/responsibilities. Studies were further categorized into one of two groups: (1) those that utilized predetermined interventions based on anecdotal experience or prior literature (18, 47.4%) and (2) those that conducted a prospective analysis on baseline data to inform intervention development (20, 52.6%). Discussion There are significant variability in the methodologies utilized to improve OR TOT; however, the most effective solutions involved process redesign bundles developed from a prospective investigation of the clinical work‐system.