title: Efficiency improvement in the operating room.
abstract: In the changing health care environment, health systems, hospitals, and health care providers must focus on improving efficiency to meet an increasing demand for high-quality, low-cost health care. Much has been written about strategies and efforts to improve efficiency in the perioperative periods, yet the time when the patient is in the operating room-the intraoperative period-has received less attention. Yet, this is the period in which surgeons may have the most influence.
  
  
  
  Systematically review published efforts to improve intraoperative efficiency; assess the outcomes of these efforts, and propose standardized reporting of future studies.
  
  
  
  A total of 39 studies were identified that met inclusion criteria. These divided naturally into small (single operative team), medium (multi-operative team), and large (institutional) interventions. Most studies used time or money as their metric for efficiency, though others were used as well.
  
  
  
  There is substantial opportunity to enhance operating room efficiency during the intraoperative period. Surgeons may have a particular role in procedural efficiency, which has been relatively unstudied. Common themes were standardizing tasks, collecting and using actionable data, and maintaining effective team communication.
authors: University of Chicago Operative Performance Research Institute, Chicago, Illinois; Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
authors: Abigail J
authors: AJ
authors: Fong
authors: University of Chicago Operative Performance Research Institute, Chicago, Illinois; Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois.
authors: Meghan
authors: M
authors: Smith
authors: University of Chicago Operative Performance Research Institute, Chicago, Illinois; Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois. Electronic address: alexander.langerman@vanderbilt.edu.
authors: Alexander
authors: A
authors: Langerman
mesh_terms: D017598:Efficiency, Organizational; D009873:Operating Rooms / Q000592:standards*; D058996:Quality Improvement; D057188:Workflow
keywords: Efficiency; Intraoperative; Lean; Operating room; Process mapping; Six sigma; Surgery; Total quality improvement