Improving operating room efficiency for primary joint replacements in a medium-sized rural community hospital using positive deviance seminars

BACKGROUND: Improving operating room (OR) throughput is a constant challenge. Given evidence that positive deviance (PD) sessions to identify excelling individuals and disseminate their strategies lead to improvements in a tertiary care institution, we sought to use PD sessions to increase the success in completing 4 joint arthroplasties in a day in a rural hospital. METHODS: We conducted PD sessions for 13 OR nurses, 4 family physician anesthetists or anesthesiologists, and 2 orthopedic surgeons. Best-performing staff shared strategies. We measured efficiency and agreement, which were then discussed at future PD sessions. Our primary outcome was success in completing 4 joint arthroplasties in a day. We recorded time from the patient being in the OR to anesthesia-ready (anesthesia prep time), time from the patient being anesthesia-ready to surgery start (surgery prep time), procedure length, time from surgery finish to the patient leaving the room (anesthesia finish time), and room turnover time. We collected data before PD sessions (baseline), 1 to 5 months post-PD sessions (short-term follow-up), and 9 to 13 months post-PD sessions (long-term follow-up). RESULTS: Before PD sessions, 48.7% of joint arthroplasty days were completed on time. At short- and long-term follow-up, 87.5% and 80.0% were completed on time. The average time to complete 4 cases decreased. Notable changes were made in anesthesia prep time (21 min at baseline, 17 min at both short- and long-term follow-up), and turnover time (30 min at baseline, 25 min at short-term follow-up, 23 min at long-term follow-up). CONCLUSION: Overall, PD sessions in a rural hospital increased success in completing 4 joint arthroplasties in a day with minimal costs, stimulating local strategies for efficiency. Long-term sustainability and applicability to other surgical procedures or specialties is yet to be determined.