S. Fitzgibbons1,2, S. Kaplan3, X. Lei3, S. Safford5, S. Parker4 1MedStar Georgetown University Hospital,Surgery,Washington, DC, USA 2Georgetown Univeristy Medical Center,Washington, DC, USA 3George Mason University,Psychology,Fairfax, VA, USA 4Virginia Tech Carilion School Of Medicine And Research Institute,Human Factors,Roanoke, VA, USA 5Carillion Clinic,Pediatric Surgery,Lynchburg, VA, USA
Introduction: The composition of any given operating room team may vary procedure-to-procedure. Studies in healthcare have documented that greater familiarity between certain team member pairs or dyads (ex. surgeon and scrub) corresponds to improved effectiveness, with outcomes ranging from shorter cross clamp times during cardiopulmonary bypass to shorter operative times during mammoplasty. We sought to further our understanding of this effect beyond simple dyads by developing an OR team familiarity score reflective of the larger and more complex group, and determining the impact of the larger group familiarity on surgical processes and clinical outcomes.
Methods: Data from a diverse, primarily urban healthcare system including 6 acute-care hospitals was extracted from a system-wide electronic medical record. All knee arthroplasty cases performed between 2013 and 2016 were included in the data set. Information regarding individual OR team participants and their roles in the surgery were collected, in addition to patient demographics (ASA class, age, gender, race, ethnicity), case information (surgical procedure, date and time of the operation) and outcome variables (length of procedure, length of hospital stay). Team familiarity was calculated using a previously published formula from Huckman, Staats, and Upton (2009). A multilevel regression (i.e., random coefficient modeling) framework was applied to examine the impact of a team’s familiarity score on case length and post-op length of stay. In addition, specific familiarity scores for each possible dyad on the team was calculated and analyzed. Dyads were defined as pairs of core team members: surgeon, scrub, circulator, anesthesiologist.
Results:A total of 4546 knee arthroplasty cases were included in the data set with an average case length of 92.68 minutes and an average length of hospital stay of 3.22 days. When controlling for patient age, gender, hospital, and ASA class, a team’s familiarity score during a case was significantly associated with a shorter case length, with 10 previous team member interactions predicting a decreased case length of approximately 1.1 minutes (p=.012). Similarly, an increased team familiarity score predicted a decreased length of stay, with 10 previous team member interactions predicting a decrease in hospital length of stay of 0.1 days. With respect to the impact of specific dyad familiarity, all dyads involving the circulator predicted a shorter length of hospital stay, while all three dyads between the surgeon, scrub and circulator predicted a shorter case length.
Conclusion:Overall team member familiarity in the operating room is associated with a small but significant decrease in the case length and hospital length of stay for patients undergoing total knee arthroplasty.