Improving surgical efficiency: Insights from turnover time analysis in a tertiary care center in Puerto Rico

Introduction

Operating room (OR) turnover time (TOT) significantly impacts hospital efficiency, patient care, and revenue. Delays in TOT are associated with increased operational costs, patient waiting times, and staff burden. While much of the existing literature focuses on high-resource settings, there is limited research on OR efficiency in low-resource environments. This study aims to evaluate OR turnover times in a tertiary care hospital in Puerto Rico, examining the causes of delays and their impact on departmental efficiency across various operating rooms.

Results

A total of 1036 elective surgeries were reviewed across four surgical departments. Mean turnover time (TOT) varied significantly by department, with the cardiac catheterization OR having the lowest mean TOT of 26 min, and the ObGyn OR having the highest at 56 min. The rate of delays also varied, with the general OR having the highest percentage of delayed cases at 17.7 %, and the catheterization lab the lowest at 6.6 %. Overall, delayed cases had a significantly longer TOT (mean 1 h 11 min) compared to non-delayed cases (mean 31 min, p < 0.001). The causes of delays varied by department and included surgeon unavailability, inadequate staffing, cleanup inefficiencies, among others.

Discussion

Our findings highlight key factors contributing to TOT delays, which vary across different surgical departments. Strategies such as implementing dedicated turnover teams, optimizing surgeon scheduling, and improving communication with task-specific checklists could reduce delays and improve OR efficiency. While the study's scope is limited to a single institution in Puerto Rico, it provides insights for improving OR efficiency in similar low-resource settings.