title: Elective change of surgeon during the OR day has an operationally negligible impact on turnover time.
abstract: OBJECTIVE
  To compare turnover times for a series of elective cases with surgeons following themselves with turnover times for a series of previously scheduled elective procedures for which the succeeding surgeon differed from the preceding surgeon.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University-affiliated teaching hospital.
  
  
  METHODS
  The operating room (OR) statistical database was accessed to gather 32 months of turnover data from a large academic institution. Turnover time data for the same-surgeon and surgeon-swap groups were batched by month to minimize autocorrelation and achieve data normalization. Two-way analysis of variance (ANOVA) using the monthly batched data was performed with surgeon swapping and changes in procedure category as variables of turnover time. Similar analyses were performed using individual surgical services, hourly time intervals during the surgical day, and turnover frequency per OR as additional covariates to surgeon swapping.
  
  
  RESULTS
  The mean (95% confidence interval [CI]) same-surgeon turnover time was 43.6 (43.2 - 44.0) minutes versus 51.0 (50.5 - 51.6) minutes for a planned surgeon swap (P < 0.0001). This resulted in a difference (95% CI) of 7.4 (6.8 - 8.1) minutes. The exact increase in turnover time was dependent on surgical service, change in subsequent procedure type, time of day when the turnover occurred, and turnover frequency.
  
  
  CONCLUSIONS
  The investigated institution averages 2.5 cases per OR per day. The cumulative additional turnover time (far less than one hour per OR per day) for switching surgeons definitely does not allow the addition of another elective procedure if the difference could be eliminated. A flexible scheduling policy allowing surgeon swapping rather than requiring full blocks incurs minimal additional staffed time during the OR day while allowing the schedule to be filled with available elective cases.
authors: Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. Electronic address: thomas.austin@vanderbilt.edu.
authors: Thomas M
authors: TM
authors: Austin
authors: Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors: Humphrey V
authors: HV
authors: Lam
authors: Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
authors: Naomi S
authors: NS
authors: Shin
authors: Perioperative Services, Massachusetts General Hospital, Boston, MA 02114, USA.
authors: Bethany J
authors: BJ
authors: Daily
authors: Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA.
authors: Peter F
authors: PF
authors: Dunn
authors: Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors: Warren S
authors: WS
authors: Sandberg
mesh_terms: D000704:Analysis of Variance; D015331:Cohort Studies; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D066231:Surgeons / Q000458:organization & administration*; D013997:Time Factors
keywords: Operating room efficiency; Surgeon swapping; Turnover times