title: High efficiency endocrine operation protocol: From design to implementation.
abstract: We developed a high efficiency endocrine operative protocol based on a mathematical programming approach, process reengineering, and value-stream mapping to increase the number of operations completed per day without increasing operating room time at a tertiary-care, academic center.
  
  
  
  Using this protocol, a case-control study of 72 patients undergoing endocrine operation during high efficiency days were age, sex, and procedure-matched to 72 patients undergoing operation during standard days. The demographic profile, operative times, and perioperative complications were noted.
  
  
  
  The average number of cases per 8-hour workday in the high efficiency and standard operating rooms were 7 and 5, respectively. Mean procedure times in both groups were similar. The turnaround time (mean ± standard deviation) in the high efficiency group was 8.5 (±2.7) minutes as compared with 15.4 (±4.9) minutes in the standard group (P < .001). Transient postoperative hypocalcemia was 6.9% (5/72) and 8.3% (6/72) for the high efficiency and standard groups, respectively (P = .99).
  
  
  
  In this study, patients undergoing high efficiency endocrine operation had similar procedure times and perioperative complications compared with the standard group. The proposed high efficiency protocol seems to better utilize operative time and decrease the backlog of patients waiting for endocrine operation in a country with a universal national health care program.
authors: Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, Canada.
authors: Marco A
authors: MA
authors: Mascarella
authors: Department of Mathematical and Industrial Engineering, Polytehcnique Montreal, Montreal, Canada.
authors: Nadia
authors: N
authors: Lahrichi
authors: Department of Nursing, Jewish General Hospital, Montreal, Canada.
authors: Fabienne
authors: F
authors: Cloutier
authors: Department of Anesthesia, McGill University, Montreal, Canada.
authors: Simcha
authors: S
authors: Kleiman
authors: Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, Canada.
authors: Richard J
authors: RJ
authors: Payne
authors: Department of Surgery, Jewish General Hospital, McGill University, Montreal, Canada. Electronic address: lawrence.rosenberg@mcgill.ca.
authors: Lawrence
authors: L
authors: Rosenberg
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000328:Adult; D002170:Canada; D016022:Case-Control Studies; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009873:Operating Rooms / Q000458:organization & administration*; D061646:Operative Time; D016105:Parathyroidectomy / Q000592:standards* / Q000639:trends; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D017064:Process Assessment, Health Care; D012015:Reference Standards; D013965:Thyroidectomy / Q000592:standards* / Q000639:trends; D014850:Waiting Lists