How Engaged Interdependence Impacts Operating Room Management Metrics

Abstract Objective In this retrospective case study, we examine the impact of an operational coaching-based initiative, Engaged Interdependence, on operating room efficiency. Design Engaged Interdependence is a professional development model that allows surgeons to expand their technical and managerial skills. Engaged Interdependence is composed of three parts and includes 6-8 hours of direct operating room surgeon-to-surgeon observation or assistance once every other month, one-hour group discussions every month and 4-6 hours of independent reading every month. Surgeon RM began coaching surgeon DL on 2/1/2017. We collected 12 months before and after the start data, splitting the data into a Before and an On/After groups for statistical and graphical comparison. All operating room management data were collected using WiseOR® and OR efficiency was assessed using four metrics: OR workload (patient time in room plus turnover time), operating time, over-utilized (OU) time, and under-utilized (UU) time. OR workload and operating time were analyzed using a Wilcoxon rank sum test, while OU and UU time were analyzed using a two-tailed t-test. Setting Small, academic medical center. Participant A single orthopedic spine surgeon. Results OR workload hours significantly decreased for four of five most common procedures: Procedure 1 “Laminectomy, Part Facetectomy, Foraminotomy, Herniated Disc Lumbar” (Before Mean [M] ± Standard Deviation [SD]=2.09±0.42 hours, After M=1.95±0.42; p=0.077); Procedure 2 “Laminectomy with Facetectomy + Foraminotomy, Lumbar” (Before M=2.95±0.77 hours, After M=2.41±0.55; p=0.022); Procedure 3 “Posterior Non-Segmental Instrumentation” (Before M=4.11±0.66, After M=3.52±0.76; p=0.014); Procedure 4 “Laminectomy, Facetectomy + Foraminotomy Additional Segment” (Before M=4.05±0.94, After M=2.80±0.32; p=0.0018); and Procedure 5 “Posterior Segmental Instrumentation- 3-6 Vertical Segments” (Before M=6.40±0.83, After M=4.62±1.1; p=0.0065). Operating time hours significantly decreased for all five procedures: Procedure 1 (Before M=1.34±0.38, After M=1.17±0.32, p=0.026), Procedure 2 (Before M=2.15±0.71, After M=1.61±0.54, p=0.0058), Procedure 3 (Before M=3.18±0.67, After M=2.70±0.63, p=0.032), Procedure 4 (Before M=2.92±0.69, After M=2.09±0.29, p=0.014), and Procedure 5 (Before M=5.43±0.83, After M=3.58±1.0, p=0.0032). OU time minutes significantly decreased (Before M=20.5±34.8, After M=10.1±22.8, p=0.014), while UU time remained unchanged (Before M=16.2±22.3, After M=23.4±28.7, p=0.063). Conclusion Engaged Interdependence represents a potential high-value intervention that can improve operating room efficiency. Although operational coaching is a subjective process, perioperative health care systems may generate a return on investment by fostering operational and organizational decision-making skills.