title: Improving operating theatre efficiency: an intervention to significantly reduce changeover time.
abstract: BACKGROUND
  Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays.
  
  
  METHODS
  A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken.
  
  
  RESULTS
  There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13).
  
  
  CONCLUSIONS
  The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times.
authors.affiliation: Urology Department, Westmead Hospital, Sydney, New South Wales, Australia. bish.soliman@gmail.com
authors.forename: Bishoy A B
authors.initials: BA
authors.lastname: Soliman
authors.forename: Raymond
authors.initials: R
authors.lastname: Stanton
authors.forename: Steven
authors.initials: S
authors.lastname: Sowter
authors.forename: Warren Matthew
authors.initials: WM
authors.lastname: Rozen
authors.forename: Shekib
authors.initials: S
authors.lastname: Shahbaz
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000768:Anesthesia, General; D001315:Australia; D015331:Cohort Studies; D004526:Efficiency; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration*; D013997:Time Factors; D017748:Time Management / Q000458:organization & administration*; D013520:Urologic Surgical Procedures