title: Improving outcomes in a high-output pediatric otolaryngology practice.
abstract: OBJECTIVE
  To identify factors associated with efficient operating room work flow on high volume pediatric otolaryngology days and the effects on provider and perceived parent satisfaction.
  
  
  METHODS
  Retrospective review was performed of a sample of 20 days with greater than 10 cases per day performed by a pediatric otolaryngologist operating in 2 rooms. Turnover time and complications were the main outcome measures. Providers from otolaryngology and anesthesia that participated in these days were surveyed regarding efficiency, safety, and satisfaction.
  
  
  RESULTS
  223 cases were performed over 20 operative days. The average turnover time was significantly longer in "major" surgeries (p=0.03), cases with multispecialty involvement (p=0.01), cases requiring intubation (p<0.001), and in cases where a fellowship trained pediatric anesthesiologist (p=0.01) or CRNA was present (p<0.001). When comparing "fast" (<25min average turnover) operative days vs. "slow" (>25min average turnover) days, presence of a non-fellowship trained anesthesiologist (p<0.001), and the presence of an anesthesiology resident (p=0.03) were significantly associated with "fast" days, while the presence of a CRNA was associated with "slow" days (p<0.001). A significantly greater proportion of patients required intubation on "slow" turnover days vs. "fast" days (p=0.13). Only one complication was observed (0.4%). 48 providers were surveyed with a 63% response rate. Reported satisfaction amongst providers was significantly greater on days with at least 10 cases (p=0.047) and on days with turnover times of 25min or less (p<0.001). Pre-operative nursing evaluation/preparation of the patient, inter-provider communication and delays in room cleaning/setup were identified most often as causative factors responsible for delays in turnover.
  
  
  CONCLUSIONS
  High-operative volume operating days are common in pediatric otolaryngology and can be safely performed in an efficient manner. Appropriate scheduling and high-level communication between providers is needed to ensure success on these days. Identified areas of potential inefficiency can be a starting point for work flow optimization practices.
authors.affiliation: Tulane University, Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, SL 59, New Orleans, LA 70112, United States. Electronic address: jcarter9@tulane.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Carter
authors.affiliation: Tulane University, Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, SL 59, New Orleans, LA 70112, United States. Electronic address: rileycaf@gmail.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Riley
authors.affiliation: Tulane University, Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, SL 59, New Orleans, LA 70112, United States. Electronic address: aananth@tulane.edu.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Ananth
authors.affiliation: Ochsner Health System, United States. Electronic address: lguarisco@ochsner.org.
authors.forename: J Lindhe
authors.initials: JL
authors.lastname: Guarisco
authors.affiliation: Ochsner Health System, United States. Electronic address: kirodriguez@ochsner.org.
authors.forename: Kimsey
authors.initials: K
authors.lastname: Rodriguez
authors.affiliation: Ochsner Health System, United States. Electronic address: ramadee@ochsner.org.
authors.forename: Ronald
authors.initials: R
authors.lastname: Amedee
mesh_terms: D000776:Anesthesiology; D002648:Child; D002675:Child, Preschool; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008297:Male; D009873:Operating Rooms / Q000458:organization & administration*; D061646:Operative Time; D013517:Otorhinolaryngologic Surgical Procedures; D061214:Patient Safety; D017060:Patient Satisfaction; D010372:Pediatrics; D010561:Personnel Staffing and Scheduling; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014481:United States; D016526:Workload
keywords: Efficiency; High volume; Operating room; Pediatric otolaryngology; Turnover time