Stretcher vs Table for Operative Hand Surgery.

Abstract

Background: Starting in October 2021, the Malcom Randall Veterans Affairs Medical Center Plastic Surgery Service began keeping patients undergoing hand surgery on the stretcher in the operating room (OR) as a time-saving initiative. The objective of this study was to evaluate this new process in terms of OR time efficiency, cost savings, and safety.

Methods: A retrospective chart review was conducted for hand surgery cases performed in the same OR by the same surgeon over 2 year-long periods: October 1, 2020, through September 30, 2021, when surgeries were performed on the OR table, and June 1, 2022, through May 31, 2023, when surgeries were performed on the stretcher. Time intervals obtained from the electronic medical record were "patient in OR" to "operation begin," "operation end" to "patient out OR," and "patient out OR" to next "patient in OR." The median times were compared between the periods. The Patient Safety and Employee Health offices were queried for reported patient or employee-patient transfer injuries. The Inventory Supply department provided the cost of materials used in the transfer process.

Results: A total of 306 hand surgeries were performed on a table and 191 were performed on a stretcher. The median time interval from in-room to operation begin was 25 minutes for the table and 23 minutes for the stretcher. The median time from operation end to patient out of OR was 4 minutes for the table and 3 minutes for the stretcher. Median room turnover time was 27 minutes for both time periods. There were no reported employee or patient injuries attributed to OR transfers during either time period. Supply cost savings was $111.28 per case when surgery was performed on the stretcher.

Conclusions: Hand surgery can be safely performed on the stretcher while reducing both time and costs. Over the course of a year, these savings can translate to $57,866 in supply costs and 26 hours of OR time.