title: Working toward benchmarks in orthopedic OR efficiency for joint replacement surgery in an academic centre.
abstract: BACKGROUND
  The introduction of 4-joint operating rooms (ORs) to meet provincial wait time targets represented a major change in practice, providing an opportunity to optimize patient care within an OR time allotment of 8 hours. We reviewed our success rate completing 4 joint replacements within 8 hours and defined benchmarks for successful completion.
  
  
  METHODS
  We reviewed the surgeries performed in the 4-joint ORs between May and October 2012. Using prospectively collected data from the Surgical Information Management System, each surgery time was divided into the following components: anesthesia preparation time (APT), surgical preparation time (SPT), procedure duration, anesthesia finishing time (AFT) and turnover time. We defined success as 4 joint replacements being completed within the allotted time.
  
  
  RESULTS
  We reviewed 49 4-joint OR days for a total of 196 joint surgeries. Of the 49 days, 24 (49%) were successful. Only 2 surgeons had a success rate greater than 50%. Significant predictors of success were APT (odds ratio 1.09, 95% confidence interval [CI] 1.02-1.16), procedure duration (odds ratio 1.02, 95% CI 1.00-1.05) and AFT (odds ratio 1.19, 95% CI 1.06-1.34). We calculated probabilities for each component and derived benchmark times corresponding to the probability of 0.60. These benchmarks were APT of 9 min, SPT of 14 min, procedure duration of 68 min, AFT of 4 min and turnover of 15 min.
  
  
  CONCLUSIONS
  We established benchmark times for the successful completion of 4 primary joint replacements within an 8-hour shift. Targeted interventions could maximize OR efficiency and enhance multidisciplinary care delivery.
authors.affiliation: All authors are from the Orthopedic Department, the Ottawa Hospital, Ottawa, Ont.
authors.forename: Paule E
authors.initials: PE
authors.lastname: Beaulé
authors.affiliation: All authors are from the Orthopedic Department, the Ottawa Hospital, Ottawa, Ont.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Frombach
authors.affiliation: All authors are from the Orthopedic Department, the Ottawa Hospital, Ottawa, Ont.
authors.forename: Jae-Jin
authors.initials: JJ
authors.lastname: Ryu
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement; D019985:Benchmarking; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000458:organization & administration*; D012189:Retrospective Studies