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#Grand Rounds

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

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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

METHODS:

  • Retrospective review
  • Participants: Women undergoing prolapse surgery
  • Following factors were abstracted
    • Demographics
    • Procedure
    • OR
    • Anesthetic
    • Surgical time
    • Number of handoffs between anesthesia members
    • Circulators
    • Surgical technologies
    • Number of learners

RESULTS:

  • 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).

CONCLUSION:

  • 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

Learn More – Primary Sources:

Operating Room Efficiency: Examining the Impact of Personnel Handoffs

 

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Related ObG Topics:

Mesh and Pelvic Organ Prolapse: ACOG Practice Advisory & ACOG/AUGS Recommendations 
Is Pelvic Muscle Strengthening Effective Following Pelvic Surgery for Prolapse and Incontinence?
Robotic vs Vaginal vs Open Surgery for Vaginal Prolapse – How Do They Compare?

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