Task analysis of the preincision surgical period: an independent observer-based study of 1558 cases

Area of Science:

• Anesthesiology
• Operating Room Management
• Health Services Research

Background:

• Operating room (OR) efficiency is crucial for healthcare systems.
• The preincision period, encompassing anesthesia release time (ART) and surgical preparation time (SPT), significantly impacts overall OR workflow.
• Understanding factors influencing these times is essential for optimizing scheduling and resource allocation.

Purpose of the Study:

• To prospectively measure anesthesia release time (ART) and surgical preparation time (SPT) in elective surgery patients.
• To identify factors, including delays, that affect the duration of ART and SPT.
• To inform more accurate OR scheduling and administrative expectations.

Main Methods:

• Prospective observational study involving 1558 elective surgery patients at a tertiary medical center.
• Trained independent observers measured ART (patient-on-table to release for prep) and SPT (prep start to incision).
• Multivariate regression analysis was used to identify predictors of ART duration and analyze delay occurrences.

Main Results:

• Mean ART was 21 ± 16 minutes and mean SPT was 22 ± 13 minutes, with significant variation (ART range: 1-115 min; SPT range: 1-130 min).
• Predictors of longer ART included ASA physical status, patient age, resident training level, invasive monitoring, case length, and room case number.
• Delays occurred in 24.5% of procedures, predominantly in surgery (66.8%), followed by anesthesiology (21.7%) and logistical issues (11.5%).

Conclusions:

• Assigning a fixed duration for anesthetic induction is inappropriate for OR scheduling.
• Significant variability in preincision times necessitates flexible scheduling approaches.
• Identifying and mitigating delays in ART and SPT can improve OR efficiency and reduce administrative errors.