title: Measure to quantify the influence of time from end of surgery to tracheal extubation on operating room workflow.
abstract: BACKGROUND
  The impact of delays in extubation on operating room (OR) workflow are challenging to assess because such delays may or may not be a bottleneck to the patient leaving the OR. We developed an observational measure that quantifies the influence of extubation times on OR workflow.
  
  
  METHODS
  The time from dressing on the patient (or its functional equivalent) to tracheal extubation was observed in ORs, among a cohort of adult patients undergoing elective (scheduled) general anesthesia. During the first 36 extubations, the measure was developed using qualitative methods. During the subsequent 64 extubations, qualitative observation was supplemented with quantitative measurement. Interrater reliability was assessed during the final 30 of the 64 extubations. Video 1 (see Supplemental Digital Content 1, http://links.lww.com/AA/A396) shows animation of a typical observation period.
  
  
  RESULTS
  The developed measure was a single value for each case: whether at least 1 person was doing no visible physical activity potentially related to patient care for at least 1 minute between dressing on the patient and tracheal extubation. Assessing reliability, 2 raters' listings of cases with no versus 1 or more people idle were identical for 30 of 30 cases (95% lower confidence limit >90%). Spearman r = 0.99 (95% lower confidence limit 0.99) for time from dressing on patient to extubation. Predictive validity was shown by positive correlation between the percentage of cases with at least 1 person idle and extubation time (P < 0.0001): 21% for <5 minutes, 42% for 5 to 10 minutes, 87% for 10 to 15 minutes, and 100% for >15 minutes.
  
  
  CONCLUSIONS
  Longer times to extubation are associated with an increased chance of at least 1 person waiting in the OR. This measure can be used in observational studies and for lean engineering projects to assess conditions when time to extubation affects workflow. Observers can combine use of this measure for extubation times with the previously developed measure for studying the influence of induction times on OR workflow.
authors.affiliation: Department of Anesthesiology, The State University of New York Upstate Medical University, Syracuse, NY, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Masursky
authors.forename: Franklin
authors.initials: F
authors.lastname: Dexter
authors.forename: Michael O
authors.initials: MO
authors.lastname: Kwakye
authors.forename: Bettina
authors.initials: B
authors.lastname: Smallman
mesh_terms: D060666:Airway Extubation; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D017598:Efficiency, Organizational; D017558:Elective Surgical Procedures; D006801:Humans; D009518:New York; D009873:Operating Rooms / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D013997:Time Factors; D017748:Time Management; D014741:Video Recording; D057188:Workflow