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Operating room first case start times: a metric to assess systems-based practice milestones?
Journal article   Open access   Peer reviewed

Operating room first case start times: a metric to assess systems-based practice milestones?

Christopher Ryan Hoffman, Jay Horrow, Shreyas Ranganna and Michael Stuart Green
BMC medical education, v 19(1), pp 446-446
02 Dec 2019
DOI: https://doi.org/10.1186/s12909-019-1886-2
PMID: 31791314
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1186/s12909-019-1886-2View
Published, Version of Record (VoR)CC BY V4.0,  Open

Abstract

Adolescent Adult Aged Clinical Competence - standards Clinical Competence - statistics & numerical data Female Humans Internship and Residency - standards Internship and Residency - statistics & numerical data Linear Models Male Middle Aged Operating Rooms - standards Operating Rooms - statistics & numerical data Operative Time Retrospective Studies Surgical Procedures, Operative - standards Surgical Procedures, Operative - statistics & numerical data Systems Analysis Time Factors Young Adult
Resident competence in peri-operative care is a reflection on education and cost-efficiency. Inspecting pre-existing operating room metrics for performance outliers may be a potential solution for assessing competence. Statistical correlation of problematic benchmarks may reveal future opportunities for educational intervention. Case-log database review yielded 3071 surgical cases involving residents over the course of 5 years. Surgery anticipated and actual start times were evaluated for delays and residents were assessed using the days of resident training performed at the time of each corresponding case. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status classification (ASA PS), and in-patient versus day surgery status. Mixed-effect, multi-variable, linear regression determined independent determinants of delay time. The analysis identified day of the week (F = 25.65, P < 0.0001), days of training (F = 8.39, P = 0.0038), attending surgeon (F = 2.67, P < 0.0001), and anesthesiology resident (F = 1.67, P = 0.0012) as independent predictors of delay time for first-start cases, with an overall regression model F = 3.09, r  = 0.186, and P < 0.0001. The day of the week and attending surgeon demonstrated significant impact of case delay compared to resident days trained. If a learning curve for first-case start punctuality exists for anesthesiology residents, it is subtle and irrelevant to operating room efficiency. The regression model accounted for only 19% of the variability in the outcome of delay time, indicating a multitude of additional unidentified factors contributing to operating room efficiency.

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10 citations in Web of Science
11 citations in Scopus

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Collaboration types
Domestic collaboration
Web of Science research areas
Education & Educational Research
Education, Scientific Disciplines
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