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Original Investigation
June 20, 2019

Association of Surgical Setting and Deployment of a New Electronic Health Record With Ophthalmic Operative Times

Author Affiliations
  • 1Department of Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Oakland University William Beaumont School of Medicine, Rochester, Michigan
  • 3Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 4Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. 2019;137(9):969-974. doi:10.1001/jamaophthalmol.2019.1938
Key Points

Question  How are the implementation of a new electronic health record and a new surgical setting associated with operative times for ophthalmic surgery?

Findings  In this study of more than 11 064 ophthalmic surgeries performed by 76 surgeons, room duration was significantly shorter (11.9 minutes per case) for cataract surgery when performed at ambulatory surgical centers relative to the hospital outpatient department. After the deployment of a new electronic health record system, the total operating room time was significantly longer (2.9 minutes per case) in the immediate posttransition period, but no significant difference was observed more than 100 days after the implementation.

Meaning  These results have implications for institutional operative planning and resource allocation for ophthalmic surgery.

Abstract

Importance  Determining the association of surgical setting and implementation of a new electronic health record (EHR) system with ophthalmic operative times is important for surgical planning and resource allocation.

Objective  To assess the associations of surgical setting and EHR system replacement with operative times for ophthalmic surgery.

Design, Setting, and Participants  This case series included ophthalmic surgeries from July 2015 to November 2016 in 2 ambulatory surgical centers and 1 hospital outpatient department in a single academic eye institute. Operative times from consecutive surgical cases performed by board-certified ophthalmologists were extracted from 2 EHR systems. Those performed after replacement EHR system implementation were divided into three 50-day time categories (immediate posttransition, intermediate posttransition, and late posttransition periods). Multivariable regression analyses assessed the associations of surgical setting (hospital outpatient department vs ambulatory surgical center) with total operating room times for comparable surgeons performing cataract surgery and deployment of a new EHR system in the OR on several operative time measures. Data were evaluated from November 2016 to March 2018.

Main Outcomes and Measures  Room duration, procedure duration, turnaround time, and total OR time.

Results  A total of 11 064 cases performed by 76 surgeons were included in this analysis. The mean total OR time was 2.9 (95% CI, 0.5-5.4; P = .02) minutes longer in the immediate posttransition period and 1.2 (95% CI, 0.1-2.2; P = .04) minutes longer in the intermediate posttransition period relative to surgeries performed before EHR system replacement. No difference in the total OR time was found between the late posttransition and pretransition periods. Relative to ambulatory surgical centers, the mean total OR time was 15.9 (95% CI, 14.7-17.0) minutes longer, and the mean turnaround time was 5.1 (95% CI, 4.3-6.0) minutes longer at the hospital outpatient department for comparable surgeons performing cataract surgery (P < .001 for both).

Conclusions and Relevance  The mean total OR time per case lengthened after the replacement of an EHR system in the OR, but this increase was small (shorter than 3 minutes) and limited to surgeries performed during the first 100 days after the EHR system transition. Modeling to assess surgical setting demonstrated all operative time measures were longer for cataract cases performed at the hospital outpatient department relative to those at ambulatory surgical centers. These data have implications for the fiscal and logistical management of ophthalmic surgery.

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