Using human factors to improve workflow and efficiency in the hybrid operating room
Tara Cohen, Daniel Miles, Cassra Arbabi, Sarah Francis, Sali Chahout, Cecille Pellagao, Johnny Thomas, Navyash Gupta, Ali Azizzadeh
Cedars-Sinai Medical Center, Los Angeles, CA
INTRODUCTION: Hybrid operating rooms (ORs) function at the intersection between traditional ORs and cath labs, creating opportunities to perform surgical procedures with advanced imaging capabilities. The integration of different OR/cath lab teams, supplies and equipment can lead to inefficiencies. Human factors is the science investigating the relationships between humans and work system factors to improve safety, efficiency and wellbeing. We evaluated the application of human factors principles to improve workflow and efficiency of the hybrid OR.
METHODS: Research was conducted at a tertiary hospital with one hybrid OR. Barriers to efficiency and workflow were investigated via retrospective medical record review, embedded observation and staff surveys. Opportunities for improvement were grouped into 3 categories: first case on-time starts, procedural efficiency, and turn-over efficiency. Baseline data was used to develop a bundle of interventions: (1) a “team huddle” to create shared mental models and increase situational awareness; (2) standardized preference cards; (3) consolidated open and endovascular table setup; (4) reconfiguration of equipment and space usage; (5) cross-training open and endovascular staff; (6) gaining commitment from stakeholders to improve case start time. Data was analyzed at 6 and 13 months post intervention.
RESULTS: Retrospective data analysis over one year (12/1/2017 - 12/1/2018) revealed that first cases rarely started on time (15%) and turnovers required an average of 59.5 min. Embedded observations revealed miscommunication and poor coordination between OR and cath-lab staff. Survey results revealed an overall baseline satisfaction score of (2.07/5). Survey comments revealed dissatisfaction with efficiency, communication, equipment, room layout and training. At 6 months post intervention, data analysis (6/2019 - 12/2019) demonstrated, first case on time starts increased to 24%, turnover time decreased to 55 min and satisfaction with overall efficiency increased (3.17/5). At final evaluation, data analysis (1/1/2020 - 7/30/2020) demonstrated further increase in first case on time starts (41%), a decreased turnover time of 53 min and increased satisfaction with overall efficiency (4.23/5) (Figure 1). CONCLUSIONS:By using a human factors approach, we identified systemic barriers to safe and efficient hybrid room processes and developed data driven interventions which successfully broke down these barriers. The application of human factors principles is well suited for improving the workflow and efficiency of operating rooms.
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