Technological growth is supposed to increase efficiency and thereby leisure, but often, it only seems to increase complexity, not only of the devices themselves, but of everything surrounding their use. A recent piece from JAMA offers an OR-overview concept that could improve efficiency and reduce management complexity. Proverbially, “more for less.” The idea rips a page out of the FAA’s air traffic controller playbook, or maybe a covert-operations security room, depending on your taste in movies.

The idea consists of a scrub nurse who sits in a room fed by cameras from every OR. Not only does this improve the critical OR air quality by reducing door openings during surgery, but it also allows real-time, continuous monitoring of all OR activities at once. This idea is called SAR, Surgical Activity Regulation, but it could as well be Streamlined Adaptive Reviewing, considering the situational control it grants to whoever sits in the chair.

Furthermore, the SAR program includes a weekly meeting between coordinators, nurses, surgeons, anesthesia, OR managers, etc. The purpose is straightforward: analyze the successes and failures of the previous week, then make a better plan for the upcoming week. Many needs and constraints must be considered: those of each surgical specialty, availability of equipment/staff, and so on. On a less-thrilling note, things like expected surgical duration can influence scheduling, so implementation of SAR would require both doctors and patients to accommodate. On the other hand, these clinicians have wanted to smooth out the lumpy, potholed road through the OR for many years, and several approaches have been tried. SAR’s distinctions are twofold: preemptive scheduling to avoid things like last-minute cancellations; and precise, moment-to-moment adaptability as situations unfold. The JAMA article offers compelling figures to support the efficacy of SAR. But, to encourage you to read the article in its entirety, I will only say that, overall, implementation of SAR saved 24 minutes of OR time per day, per OR. Annually, that savings is enormous.

Regardless of how many hospitals choose to apply SAR, its underlying concept is the way of the future. As technology takes over more of medicine, we need to consolidate human effort to keep everything running smoothly. The more we can do with technology, the more we feel we should do. But sometimes, the greatest advances come through making better use of what we already have.

Since the dawn of the OR Age, a harried nurse (or two) has run around the OR all day long, opening doors, asking questions, demanding updates and predictions, and generally trying to organize the independent actions of dozens of people to save three minutes, two feet of surgical gauze, and one partridge in a pear tree.

The result of this effort is no end of annoyance for the clinical staff, who are trying to guard a patient’s life, not estimate how long it’s going to take to repair an elderly patient’s aorta which spontaneously tore and is now disintegrating like tissue paper as the surgeon tries furiously to stitch.

This may seem an extreme example, but it lands the point. Fewer interruptions are better. Fewer OR door openings are better.

Simply, an eagle’s eye view is better.

Thanks for reading,

              Transonic Systems, Inc

                             The Measure of Better Results