Small changes in operative time can yield discrete increases in operating room throughput

Background and Purpose: Operating room throughput is influenced by the efficiency of the perioperative process ( for nonoperative time) and by the surgeon ( for operative time). Operative time is thought not to be easily amenable to deliberate reductions. We tested the hypothesis that gradual improvements in operative time had allowed one surgeon to perform additional cases during scheduled hours. Materials and Methods: The surgeon had been working in both a high-throughput and a conventional operating room for more than 1 year prior to the study. During the studied interval, we applied statistical process control analysis to time data for the surgeon performing full days of complex laparoscopic operations. Separate analyses were conducted for the conventional and high-throughput operating rooms. The average operative time for each day and the number of cases per day were plotted against sequential days for each environment. Results: Midway through the studied interval, there was a discrete 17-minute drop in operative time in both the high-throughput and the conventional environment. Throughput increased from two cases per day to three per day in the high-throughput environment. The average end time for the three-case days was 17: 15 ( range 16: 04-18: 32). Longer average operative and nonoperative times in the conventional rooms precluded performing three complex cases during regular work hours. Conclusion: There was a sudden, rather than a gradual, reduction of operative time leading to extra cases being performed. This coincided with ( 1) the surgeon being assigned a new fellow and ( 2) administrative commitment to finish three cases per day. Our original hypothesis was negated, but other controllable causes for changes in surgical throughput were identified.