Successful Strategies for Improving Operating Room Efficiency at Academic Institutions

In Response: Beattie's contention that our study missed some potential sources of inefficiency in the operating room is certainly valid. Our study was constructed to identify and eliminate the most flagrant inefficiencies in our system, the so-called "low hanging fruit." The major factors we identified-such as waiting for attending physicians, patient flow issues, and poor communication-were reduced by a combination of accurate data collection, accountability, and education. We agree with Beattie that there is still room for improvement by reducing surgery-controlled time in academic settings. Although little data exist on the impact of surgical resident training on efficiency [1], we suspect that academic surgeons will curtail unsupervised resident activity as benchmark data on surgery times become available and institutional and peer pressure is exerted. Although we do not have objective measures of the impact of our efficiency initiatives on resident training, we purposely chose interventions that would not affect anesthesia resident education. For instance, we reassigned the placement of certain regional anesthesia blocks and invasive monitors to outside of the operating room, by a resident dedicated to the "block and line" rotation, thus solidifying the experience. However, we believe that raising awareness of efficient anesthetic practice and cost-containment should be an integral part of anesthesia training and that our residents are well served by participating in this process. Finally, as Beattie suggests, the importance of psychology in this effort is not lost on anyone who has tried to implement change. We struggle to maintain our improvements by continually reinforcing efficiency awareness in combination with personal accountability and incentives for productivity. Frank J. Overdyk, MSEE, MD Susan C. Harvey, MD The Medical University of South Carolina; Charleston, SC 29425