ORIGINAL ARTICLE   

Chirurgia 2020 December;33(6):295-305

DOI: 10.23736/S0394-9508.19.05071-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

How to assess operating room performances? Analysis of the main indicators of efficiency in two Italian hospitals

Enrico ROSSO ¹ ✉, Claudio BELTRAMELLO ², Chiara BERTONCELLO ³, Chiara BERTI ⁴

¹ Hospital of Castelfranco Veneto, AULSS 2 Marca Trevigiana, Treviso, Italy; ² GIMBE, Bologna, Italy; ³ Istituto di Igiene, University of Padua, Padua, Italy; ⁴ Hospital of Mestre, AULSS 3 Serenissima, Hospital of Castelfranco Veneto, Treviso, Italy

BACKGROUND: Assessing the efficiency of the operating rooms (ORs) is important for managers. Specific indicators are described, but few studies analyze systematically all the intervals inside the ORs. The main purposes of this study are to define and measure intervals of the daily ORs activity and to share and analyze results with surgical teams, in order to improve efficiency.
METHODS: We considered 6108 interventions in two Italian hospitals (named A and B) in a nine-month period. We calculated mean (with C.I. 95%) and median of the intervals between: 1) entering - incision; 2) incision - suture; 3) suture - end of anesthesia; 4) end of anesthesia - exit; 5) entering - exit; 6) anesthesiological times. We also evaluated activity as utilization ratio.
RESULTS: The best surgery for utilization ratio is otolaryngology in hospital B (90.1%), the worst Orthopedics in Hospital A (64.7%). The overall best performer is Gynecology: its case-mix is simpler. The worst performer in anesthesiological time is Vascular Surgery (mean 47 minutes, C.I. 95% 43.9-50.1). Regarding surgeries with the same complexity, Otolaryngology has the best anesthesiological times (31.6; C.I. 30.7-32.5) and turnover times (18.3; C.I. 17.5-19.2). General Surgery and Orthopedics are more efficient in Hospital A.
CONCLUSIONS: To analyze operating room activity in its constituents allows healthcare managers to create a personal identikit for surgeries, to set benchmarks and to compare different surgeries. Increasing efficiency in ORs requires sharing results with personnel, encouraging data-driven decisions and spurring teams to find solutions instead of forcing unnecessary behaviors. In particular, the reduction of surgical and non-surgical times is really accepted by the surgical team only if followed by a real increase of productivity inside the ORs, like the addition of another operation performed in a single day of activity.

KEY WORDS: Anesthesiology; Surgery; Operaing rooms