Improving Operating Room Turnover Time in a New York City Academic Hospital via Lean

• Published in: The Annals of thoracic surgery Vol. 107; no. 4; pp. 1011 - 1016
• Main Authors: Cerfolio, Robert J., Ferrari-Light, Dana, Ren-Fielding, Christine, Fielding, George, Perry, Nissa, Rabinovich, Annette, Saraceni, Mark, Fitzpatrick, Maureen, Jain, Sudheer, Pachter, H. Leon
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2019
• Subjects: Academic Medical Centers - organization & administration; Appointments and Schedules; Education, Medical, Continuing; Efficiency, Organizational; Female; Humans; Male; New York City; Operating Rooms - organization & administration; Operative Time; Patient Care Team - organization & administration; Pilot Projects; Process Assessment, Health Care; Quality Improvement; New York City
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2018.11.071

Prolonged operating room turnover time erodes patient and employee satisfaction and value. Lean and value stream mapping was applied to three operating room teams at an academic health center in New York City, and a solution called Performance Improvement Team (PIT Crew) was piloted. Overall, 10% of operating room turnover steps were considered nonvalued and were eliminated, and 25% of previously sequential steps were performed synchronously. Seven institutional dogmas were eliminated, and three hospital policies were changed. After 35 pilot turnovers, median operating room turnover time improved from 37 minutes (range, 26 to 167 minutes) in historic matched controls to 14 minutes (range, 10 to 45 minutes, p < 0.0001) for the PIT Crew. Cost of the PIT Crew was $1,298 daily, and estimated return on investment was $19,500 per day. Lean and value stream mapping identifies nonvalued steps in operating room turnover and affords opportunities for efficiency. Once institutional rules and dogma are changed, culture and workflow improve and turnover time substantially improves. This process adds cost but is profitable. Scalability and sustainability are under further study, as is the “halo effect” on the culture in other non-PIT Crew operating rooms.