Optimizing Surgical Flow for Efficiency & Safety

Establishing a consistent routine in the operating room is the key for both increased efficiency as well as increased safety. Performing the same routine at the same pace, over and over again, leads to strong teamwork and standards that ensure the best outcomes.

We must first remind our readers, particularly the new surgeons in our ranks, that this is not about speed. Rushing is a bad idea because being hasty leads to errors which not only slow down the process and cause delays, but can also result in safety issues and sub-optimal vision.

We measure the cycle time of each surgery, which is the time it takes to complete a surgery including all steps, not just the actual surgical time. The beginning of one surgery (the time of the first incision) to the time of the beginning of the next surgery (first incision) is one complete cycle.

For our typical cataract surgeries we have a 21 minute cycle time with the following guidelines:

• 7 minutes for setting up the room, bringing the patient into the room, doing the time-out, and performing the prep and placing the drapes
• 7 minutes for the actual surgery which is from the first incision to drapes off
• 7 minutes for medicating the eye, placing a protective cover, bringing the patient out of the room, and cleaning the room

Review our previous post about efficiency and look at the case examples where we improve without having to shave even a minute from the actual surgical cut time.

In the figure above, we have a screen shot of the files from a few cases done in one operating room. The time-stamp of the video file shows the moment just prior to the first incision when the video recording was started. Notice that there is some variation in the cycle times, with the shorter cycle time being 18 or 19 minutes and the longest being 23 minutes. We can also see the differences in file sizes, with the most complex case taking 1 GB of storage versus just 0.7 GB for the shortest cases. This is the difference in surgical cut-time with complex cases such as small pupils or dense cataracts taking a bit longer. Still, the overall cycle time is 20.8 minutes on average.

This is about 3 entire cycles (surgeries) per hour in one operating room. While it is possible to try to squeeze this time even more, in our case it is not advised. This is a comfortable rate which allows for efficiency without ever feeling rushed. Our complication rate is very, very low and we have never had an issue such as wrong site or wrong IOL surgery in 20,000 cases.

Should you video record every case? We try to record many surgeries so that the footage can be reviewed, but some patients don’t want their surgeries recorded, and sometimes there are other issues. Due to the volume of surgeries and the large file sizes, we write over the routine cases and tend to save just the interesting ones for teaching here on CataractCoach.