Improving outcomes in a high-output pediatric otolaryngology practice

Int J Pediatr Otorhinolaryngol. 2014 Dec;78(12):2229-33. doi: 10.1016/j.ijporl.2014.10.018. Epub 2014 Oct 24.


Objectives: To identify factors associated with efficient operating room work flow on high volume pediatric otolaryngology days and the effects on provider and perceived parent satisfaction.

Methods: Retrospective review was performed of a sample of 20 days with greater than 10 cases per day performed by a pediatric otolaryngologist operating in 2 rooms. Turnover time and complications were the main outcome measures. Providers from otolaryngology and anesthesia that participated in these days were surveyed regarding efficiency, safety, and satisfaction.

Results: 223 cases were performed over 20 operative days. The average turnover time was significantly longer in "major" surgeries (p=0.03), cases with multispecialty involvement (p=0.01), cases requiring intubation (p<0.001), and in cases where a fellowship trained pediatric anesthesiologist (p=0.01) or CRNA was present (p<0.001). When comparing "fast" (<25min average turnover) operative days vs. "slow" (>25min average turnover) days, presence of a non-fellowship trained anesthesiologist (p<0.001), and the presence of an anesthesiology resident (p=0.03) were significantly associated with "fast" days, while the presence of a CRNA was associated with "slow" days (p<0.001). A significantly greater proportion of patients required intubation on "slow" turnover days vs. "fast" days (p=0.13). Only one complication was observed (0.4%). 48 providers were surveyed with a 63% response rate. Reported satisfaction amongst providers was significantly greater on days with at least 10 cases (p=0.047) and on days with turnover times of 25min or less (p<0.001). Pre-operative nursing evaluation/preparation of the patient, inter-provider communication and delays in room cleaning/setup were identified most often as causative factors responsible for delays in turnover.

Conclusions: High-operative volume operating days are common in pediatric otolaryngology and can be safely performed in an efficient manner. Appropriate scheduling and high-level communication between providers is needed to ensure success on these days. Identified areas of potential inefficiency can be a starting point for work flow optimization practices.

Keywords: Efficiency; High volume; Operating room; Pediatric otolaryngology; Turnover time.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anesthesiology
  • Child
  • Child, Preschool
  • Efficiency, Organizational*
  • Female
  • Humans
  • Male
  • Operating Rooms / organization & administration*
  • Operative Time*
  • Otorhinolaryngologic Surgical Procedures*
  • Patient Safety
  • Patient Satisfaction
  • Pediatrics*
  • Personnel Staffing and Scheduling
  • Quality Assurance, Health Care
  • Retrospective Studies
  • United States
  • Workload