#Grand Rounds

Personnel Handoffs in the OR: What is the Impact on Efficiency?

BACKGROUND AND PURPOSE:

There has been focus on improving OR efficiencies, but there is not a lot of data on intraoperative factors such as personnel handovers
Geynisman-Tan et al. (Female Pelvic Surgery & Reconstructive Surgery, 2018) examined whether personnel handoffs or number of learners in the OR are associated with longer OR times in women having pelvic organ prolapse surgery

148 women undergoing pelvic organ prolapse surgery were included in the study
- mean age was 54; majority white women
Procedures performed were as follows
- 31% laparoscopic sacrocolpopexies (LASCs)
- 28% robotic sacrocolpopexies (RASCs)
- 19% colpocleises
- 22% native tissue reconstructions
For minimally invasive sacrocolpopexies (LASC + RASC), mean OR time was 270 ± 65 minutes
Median handovers for sacrocolpopexies
- Anesthesia: 2 (interquartile range, 0–4)
- Surgical technology: 1 (0–3)
- Circulator handoffs: 2 (2–6)
Number of learners in the OR was 4 (interquartile range, 1–7)
Patient comorbidities and American Society of Anesthesiologists class were not associated with longer OR times
Longer OR times were
- Positively correlated with increasing numbers of anesthesia, surgical technology, and circulator handoffs
- Not correlated with the number of learners
For LASC, every technology handoff was associated with 23 additional minutes of OR time (P = 0.004)
For RASC, every technology handoff was associated with 31 additional minutes of OR time (P = 0.007)
Each circulator handoff was associated with 15 additional minutes (P = 0.05).

Increased number of anesthesia, surgical technology, and circulator handoffs were associated with longer OR times for pelvic organ prolapse surgery
Increased number of learners did not increase time in OR

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