On-site pathologist presence in the operating room: Description of an efficiency-oriented intraoperative workflow model

Background: The presence of pathologists directly in the operating room may reduce transportation time of specimens and enable rapid intraoperative diagnoses. We present the experience from the Maggiore Hospital of Bologna (Italy), where an organizational policy has located a pathology laboratory in the surgical suite. Methods: We aimed to describe the policy and its context, and to analyze the trends in surgical times before and after its implementation. Based on our knowledge of the logistics of the surgical suite, we expected a net reduction in surgical time of approximately 12 minutes, represented by a normally distributed prior (normal (–12, 5)). We used a Bayesian segmented regression model to explore whether the available data would alter these expectations. Different scenarios were explored in sensitivity analyses to assess the robustness of the main results. Results: We observed a reduction in surgery duration after the policy implementation, but the data were too noisy to substantially update the prior (posterior mean: –12.02 minutes, 95% credible interval: –21.69 to –2.28). Despite this, the observed data do not indicate any unexpected effects and remain compatible with an efficiency gain in our setting. Conclusion: While we retain moderate confidence that the policy may have improved efficiency in terms of reducing surgical times, additional research is needed to better quantify the magnitude of the effect. Since the policy impact is likely to be context-dependent, the limited generalizability of the numerical estimates should be assumed.