Intraoperative scrub nurse turnover in orthopaedic surgery procedures: An opportunity for improved operating room efficiency

J R Lex; B Entezari; J Toor; A Abbas; M Nousiainen; C Rahman; C Whyne; B Ravi

doi:10.1016/j.jhqr.2024.03.002

Intraoperative scrub nurse turnover in orthopaedic surgery procedures: An opportunity for improved operating room efficiency

J Healthc Qual Res. 2024 May-Jun;39(3):155-162. doi: 10.1016/j.jhqr.2024.03.002. Epub 2024 Apr 4.

Authors

J R Lex¹, B Entezari², J Toor³, A Abbas⁴, M Nousiainen⁵, C Rahman⁶, C Whyne¹, B Ravi⁵

Affiliations

¹ Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, Toronto, ON, Canada; Division of Orthopaedic Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada; Queen's University School of Medicine, Kingston, ON, Canada. Electronic address: bahar.entezari@sinaihealth.ca.
³ Division of Orthopaedic Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Division of Orthopaedic Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁶ Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

PMID: 38580507
DOI: 10.1016/j.jhqr.2024.03.002

Abstract

Background: Scrub nurses play a crucial role in facilitating orthopaedic surgeries, and thus intraoperative scrub nurse turnover may disrupt the workflow of the surgical team and prolong duration of surgery (DOS). The purpose of this study was to quantify the impact of intraoperative scrub nurse turnover on operative time of orthopaedic surgeries lasting less than 3h in duration.

Methods: Prospectively collected databases from two institutions were retrospectively queried to identify all orthopaedic procedures of maximum mean duration of 180min from March 4th, 2018 to August 31st, 2022. Cases were divided into two groups, those with scrub nurse turnover and those without. Propensity score matching was conducted to match groups by surgeon, hospital, patient age, gender, and ASA classification. Unpaired t-tests were used to compare mean DOS for each surgical procedure. Average treatment effect on treated (ATET) with 95% confidence intervals (CIs) were calculated.

Results: Scrub nurse turnover significantly prolonged DOS for both bone forearm facture open reduction and internal fixation (ORIF) (ATET=21.08, p=0.001), ankle ORIF (ATET=21.26, p<0.001), clavicle ORIF (ATET=16.16, p=0.028), femur intramedullary nail (ATET=11.52, p=0.003), rotator cuff repair (ATET=16.88, p<0.001), partial discectomy (ATET=10.52, p=0.001), total knee arthroplasty (TKA) (ATET=5.69, p<0.001), anterior total hip arthroplasty (THA) (ATET=8.80, p<0.001), lateral THA (ATET=7.02, p<0.001), and uncemented hip hemiarthroplasty (ATET=16.79, p=0.049).

Conclusion: Intraoperative scrub nurse turnover significantly prolongs surgical times in orthopaedic surgeries lasting up to 3h in duration. This highlights the importance of developing strategies to prevent intraoperative scrub nurse turnover to improve OR efficiency and decrease healthcare costs.

Keywords: Cirugía ortopédica; Efficiency; Eficiencia; Enfermero/a instrumentista; Listas de espera quirúrgicas; Operating room; Orthopaedic surgery; Quirófano; Scrub nurse; Surgical waitlists.

MeSH terms

Efficiency, Organizational
Female
Humans
Male
Middle Aged
Nursing Staff, Hospital
Operating Room Nursing
Operating Rooms*
Operative Time*
Orthopedic Procedures*
Personnel Turnover*
Retrospective Studies