Improving operating room efficiency by decreasing turnover times using a dedicated “fastlane” protocol

Introduction: In a value-driven healthcare system, decisions involving resource allocation and asset management are often made based on cost. Operating room (OR) cancellations or delays frequently occur due to patient and system factors, resulting in inefficacy and loss of operating time. The objective of our study was to investigate a model, “Fastlane,” for improving efficiency by increasing OR throughput for outpatient, low-complexity pediatric urology cases at a tertiary children's hospital. Methods: “Fastlane,” a 6-week pilot model during which a selected team of core surgeons, anesthesiologists, and nursing staff committed to shorter turnover times and increased number of cases per day, was tested compared to historic controls. Patients included were low-risk (ASA 1-2) outpatient, inguinal-genital surgeries that were anticipated to take less than 1 hour by the surgeon. Patients were to arrive three hours prior to surgery instead of the usual two-hour period and fast an additional hour. A dedicated postoperative location for patients to be received in the recovery area was created, and having the same nurse complete both preoperative and postoperative assessments to minimize handover time between nursing staff was instituted. Data was prospectively collected, including: the time that the patient arrived in the OR (AT), surgery start time (SST), surgery end time (SET), and time that patient left the OR (LT). Induction time (IT) was calculated as SST-AT. Turnover time was calculated as the time that the previous patient left the OR (LT) to the next patient's arrival to the OR (AT). Case length time was calculated as LT-AT. Patient controls for the study cohort were randomly selected from the prior year's OR activity logs who had undergone the same surgery by the same surgeon. Results: In total, 33 pediatric urology patients, managed by 2 surgeons, were evaluated over the 6-week period. The mean case length time was significantly shorter for “Fastlane” patients (47 minutes vs. 68 minutes for the control group; p<0.00014). Mean induction time was shorter in “Fastlane” (17 minutes vs. 21 minutes in the pilot group; p=0.047). Turnover time was significantly lower in the “Fastlane” group compared to the control cohort, with turnover times of 17 minutes vs. 26 minutes, respectively (p=0.0008; SD=9.08). Conclusions: A defined, committed team and standardized OR handoff protocol results in improved OR efficiency by reducing turnover times. This potentially increases the opportunity for optimizing the number of selected pediatric urological outpatient surgeries on a given operating schedule.