Stucky Christopher H, De Jong Marla J, Liu Yuliang
Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Bragg, NC.
University of Utah College of Nursing, Salt Lake City, UT.
J Perianesth Nurs. 2022 Feb;37(1):86-93. doi: 10.1016/j.jopan.2021.04.008. Epub 2021 Nov 21.
To examine the key factors impacting surgical team performance in a military medical center.
A retrospective, exploratory, cross-sectional design.
We reviewed 751 orthopedic surgical cases to determine the association of surgical team familiarity, surgical complexity, team size, and the presence of student registered nurse anesthetists (SRNAs) with the surgical performance measures of total operative time, turnover time, and on-time surgical start.
We found increases in surgical team familiarity significantly reduced turnover time by 7.84% (1-0.9216 = 0.0784; P = .0260) after controlling for surgical complexity and the presence of an SRNA on the team. Familiarity did not significantly impact total operative time or the odds of a first case on-time start. With a significant interaction of surgical complexity and team size on total operative time, the surgical complexity marginal effect (at the mean of team size) showed that a one-point increase prolonged total operative time by 6.89% (P < .0001), after controlling for team familiarity and an SRNA. The team size marginal effect (at the mean of surgical complexity) showed that adding one member to the surgical team prolonged total operative time by 6.45% (P < .0001), after controlling for team familiarity and an SRNA. Higher surgical complexity not only increased turnover time by 1.46% (P = .0265) while holding surgical complexity and an SRNA presence constant, but also reduced the likelihood of an on-time surgical start by 0.9359 (P = .0060). Larger teams decreased the odds of an on-time start by 0.7750 (P = .0363). We found that SRNAs potentially offer efficiency benefits, as their presence on a surgical team was associated with a 0.82% (1-0.9185 = 0.0815; P = .0007) decrease in total operative time, and a 21.01% (1-0.7899=0.2101; P = .0002) reduction in expected turnover time, after adjusting for confounding variables.
Surgical efficiency is a modifiable function of surgical teams. Although we suggest additional research, surgical leaders can potentially improve team performance by improving familiarity and forming small and cohesive surgical teams. As OR inefficiencies degrade the financial vitality of healthcare systems, surgical leaders should engage in a multifaceted program to improve efficiency by building familiarity and optimizing team size.
研究影响军事医疗中心外科团队绩效的关键因素。
回顾性、探索性横断面设计。
我们回顾了751例骨科手术病例，以确定手术团队的熟悉程度、手术复杂性、团队规模以及学生注册护士麻醉师（SRNA）的存在与总手术时间、周转时间和准时手术开始等手术绩效指标之间的关联。
我们发现，在控制手术复杂性和团队中是否有SRNA后，手术团队熟悉程度的提高显著缩短了7.84%的周转时间（1 - 0.9216 = 0.0784；P = 0.0260）。熟悉程度对总手术时间或首例手术准时开始的几率没有显著影响。由于手术复杂性和团队规模对总手术时间存在显著交互作用，在控制团队熟悉程度和SRNA后，手术复杂性的边际效应（在团队规模均值处）显示，每增加一分会使总手术时间延长6.89%（P < 0.0001）。团队规模的边际效应（在手术复杂性均值处）显示，在控制团队熟悉程度和SRNA后，手术团队增加一名成员会使总手术时间延长6.45%（P < 0.0001）。更高的手术复杂性不仅在保持手术复杂性和SRNA存在不变的情况下使周转时间增加1.46%（P = 0.0265），还使准时手术开始的可能性降低0.9359（P = 0.0060）。更大的团队使准时开始的几率降低0.7750（P = 0.0363）。我们发现，SRNA可能带来效率提升，因为在调整混杂变量后，手术团队中有SRNA与总手术时间减少0.82%（1 - 0.9185 = 0.0815；P = 0.0007）以及预期周转时间减少21.01%（1 - 0.7899 = 0.2101；P = 0.0002）相关。
手术效率是外科团队可调节的功能。尽管我们建议进行更多研究，但手术领导者可以通过提高熟悉程度和组建小型且有凝聚力的手术团队来潜在地提高团队绩效。由于手术室效率低下会削弱医疗系统的财务活力，手术领导者应开展多方面的计划，通过建立熟悉程度和优化团队规模来提高效率。
