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Operation Room Efficiency: A View From The Scrub Sink


I've spent a lot of time in the OR. One thing you learn is that the problems never seem to change, only the attempted solutions.

I've spent a lot of time in the OR. One thing you learn is that the problems never seem to change, only the attempted solutions. Like noxious weeds, you can spray them, pull them, or ignore them. You could also try to lean them to death, but they would always seem to come back each July with the arrival of new residents and fellows.

Here are the efficiency issues:

1. Building support among physicians to reduce supply costs

Lowering the implant buy, particularly in high priced cardiovascular and orthopedic implants, can save a lot of money. We are talking millions a year. The ritual of buying implants is a negotiation between the hospital purchasing authority, the vendor, and the surgeons so you can imagine what a meeting of the Value Added Committee looks like. What seems to be ignored are the millions wasted on unnecessary instruments that have to be bought, cleaned, inventoried, transported, and tracked that sit on the back table unused in 90% of the cases.

2. Blocking time.

There are two things that belong to surgeons that you never, ever, want to touch-their wallets and their block time. The new OR Golden Block Time Rule is that the surgeons who make the gold get the most block time. Loss leaders in the OR are more dangerous than an antibiotic resistant strain of E. Coli in the PACU.

3. Adjusting OR block time and releases

I think OR demand management is too complicated for even the best-trained, most experienced nurse sitting at a white board with three cell phones. Maybe it's time to install automated OR traffic control systems and offer a Masters degree for docs who want another pathway to the C-suite.

4. Proactively avoiding gaps due to equipment problems.

Surgeon: Can I have that super expensive retractor I designed please?

Scrub nurse: Sorry, doctor. We loaned that to Colorado General last night for an emergency case. It has to be gas sterilized, so it won't be available until the end of the week. Is there something else I can hand you?

5. Case start times.

Like the first flight of the day that does not start on time, the dominos start to fall when the surgeon does not make the incision on time. While getting the staff to start the first case on time is the ultimate exercise in herding cats, it has bought many second homes for Lean Methodology consultants who are sipping vodka tonics on the deck in their house in Vail while you are waiting for someone to get the consent signed.

6. Controlling turnover times.

The basic rule is that excessive turnover time is always someone else's fault, and, generally, the volume of the complaints is related to your place in the food chain while the ultimate power to make change is inversely related.

Suppose United Airlines ran your OR? I prefer an aisle seat.

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Victor J. Dzau, MD, gives expert advice
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