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Effects of Intervention and Team Culture on Operating Room Traffic

Pulido, Ricardo W. BA; Kester, Benjamin MD; Schwarzkopf, Ran MD

Quality Management in Healthcare: April/June 2017 - Volume 26 - Issue 2 - p 103–107
doi: 10.1097/QMH.0000000000000131
Quality Improvement Initiatives

Purpose: How changes in the surgical team's culture can potentially reduce operating room (OR) traffic.

Introduction: Excessive OR traffic during surgical procedures can present a risk to the patient's safety and recovery. Data suggest that limiting the number of OR personnel during the intraoperative period can reduce excessive OR traffic. However, it is unclear whether the surgeon's verbal intervention can also successfully reduce intraoperative OR traffic. This study compares traffic rates in hip and knee arthroplasty cases against traffic rates during nonarthroplasty cases to examine the effects of verbal interventions implemented by the surgeon to reduce intraoperative traffic.

Method: The study consisted of 16 orthopedic surgeons in a noninterventional group and 1 orthopedic surgeon in the interventional group. The surgeon in the interventional group implemented verbal protocols to OR staff to limit excessive intraoperative traffic. Operating room traffic was monitored for 3 consecutive months (January-March 2015) with the use of infrared automated door counters that tracked door openings when someone entered or left the OR.

Results: A total of 50 hip and knee arthroplasties cases and 157 nonarthroplasty cases were tracked during the study period. A total of 134 hours and 4482 movements were collected for the hip and knee arthroplasty cases. A total of 498 hours and 22 902 movements were collected for the nonarthroplasty cases. Comparing the 2 groups, the interventional group averaged 33 movements per hour while the noninterventional group averaged 46 movements per hour (P < .001).

Conclusions: These results suggest that operative room traffic can be reduced through simple verbal protocols established by the surgical team.

New York University, Hospital for Joint Diseases, New York (Mr Pulido and Drs Kester and Schwarzkopf).

Correspondence: Ricardo W. Pulido, BA, 16 Periwinkle Circle, Tinton Falls, NJ 07712 (

Dr Ran Schwarzkopf has received consulting from Smith & Nephew, Intellijoint, and Gauss Surgical. For the remaining authors, conflicts of interest were not declared.

© 2017Wolters Kluwer Health | Lippincott Williams & Wilkins