Abstract
Objective: 1) Understand the leading causes for process errors and delays in the otolaryngology operating room. 2) Recognize the impact of process errors and delays on patient safety, hospital costs, and environmental waste.
Method: A 4-week prospective, observational study was conducted in January 2012 evaluating 23 elective otolaryngology cases. A standardized data collection tool was developed and refined based on pilot observations. Two trained observers recorded relevant times and actions from patient check-in in the preoperative holding area to the “wheels out” time.
Results: The mean case observation time was 220.0 ± 167.8 minutes with mean duration of operation length being 107.0 ± 146.2 minutes. The perioperative period was divided into 6 stages: patient holding, room preparation, preintubation, postintubation, intraoperative, postextubation. One hundred (average of 4.3 per case) process errors were recorded, 34% of which were due to communication failures. Forty delays were observed resulting in 336 minutes of standstill delay. Again, communication failures represented the most common etiology with 17 communication failures resulting in 146 minutes of standstill delay. The preintubation stage was most affected by delay with 1 in 6 minutes comprising standstill delay.
Conclusion: This is the first study in otolaryngology to examine perioperative process errors and delays. Preoperative team discussion and use of technology represent potential strategies in minimizing communication-related process errors and standstill delays. Further work is currently being undertaken to study this critical perioperative issue in greater detail across specialties.
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