Stepaniak et al1 should be commended for demonstrating that both turnover and procedural times can be reduced with an integrated, cooperative team approach and that the appropriate identification of sequential cases results in an efficient surgical list. Although they cited the high-throughput delivery system in Smith et al,2 we believe that they did not use the appropriate metrics to measure the “efficiency” of their new approach. Using statistical process control, Smith et al2 demonstrated that they were able to increase the number of cases performed in each operating room. However, in contrast to the case-control study by Stepaniak et al,1 Smith et al2 did not demonstrate a reduction in surgical time. In fact, surgical time remained constant despite the concerted efforts of the operating room staff to improve workflow.
Tsai M. The True Cost of Operating Room Time. Arch Surg. 2011;146(7):886–887. doi:10.1001/archsurg.2011.163
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