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Inicio Journal of Healthcare Quality Research Intraoperative scrub nurse turnover in orthopaedic surgery procedures: An opport...
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Vol. 39. Issue 3.
Pages 155-162 (May - June 2024)
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Vol. 39. Issue 3.
Pages 155-162 (May - June 2024)
Original Article
Intraoperative scrub nurse turnover in orthopaedic surgery procedures: An opportunity for improved operating room efficiency
Rotación intraoperatoria del personal de enfermería en intervenciones de cirugía ortopédica: una oportunidad para mejorar la eficiencia del quirófano
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J.R. Lexa,b, B. Entezaric,d,
Corresponding author
bahar.entezari@sinaihealth.ca

Corresponding author.
, J. Toorb, A. Abbase, M. Nousiainenb,f, C. Rahmanf, C. Whynea,b, B. Ravib,f
a Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, Toronto, ON, Canada
b Division of Orthopaedic Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
c Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
d Queen's University School of Medicine, Kingston, ON, Canada
e Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
f Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Tables (3)
Table 1. Total patients undergoing orthopaedic procedures with and without intraoperative scrub nurse turnover.
Table 2. Baseline demographic characteristics of patients undergoing orthopaedic surgeries.
Table 3. Comparison of operative times for patients undergoing orthopaedic surgeries with and without intraoperative scrub nurse turnover.
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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:
Efficiency
Orthopaedic surgery
Operating room
Scrub nurse
Surgical waitlists
Resumen
Antecedentes

El personal de enfermería quirúrgico desempeña un papel crucial para facilitar las cirugías ortopédicas y, por lo tanto, la rotación intraoperatoria del personal de enfermería puede alterar el flujo de trabajo del equipo quirúrgico y prolongar la duración de la cirugía (DOS). El objetivo de este estudio consistió en cuantificar el impacto de la rotación intraoperatoria del personal de enfermería en el tiempo quirúrgico de las cirugías ortopédicas de menos de 3h de duración.

Métodos

Se consultaron retrospectivamente bases de datos recopiladas en forma prospectiva de dos instituciones para identificar todos los procedimientos ortopédicos de duración media máxima de 180min realizados entre el 4 de marzo de 2018 y el 31 de agosto de 2022. Los casos se dividieron en 2 grupos, aquellos con rotación de enfermeras instrumentistas y aquellos sin rotación. Se realizó un emparejamiento por puntuación de propensión para emparejar los grupos por cirujano, hospital, edad del paciente, sexo y clasificación ASA. Se utilizaron pruebas t no apareadas para comparar la DOS media de cada procedimiento quirúrgico. También se calculó el efecto medio del tratamiento sobre los pacientes tratados (ATET) con intervalos de confianza (IC) del 95%.

Resultados

La rotación de personal de enfermería de quirófano prolongó significativamente la DOS para la reducción abierta y fijación interna (ORIF) de la fractura del antebrazo (ATET=21,08; p=0,001), la ORIF del tobillo (ATET=21,26; p=0,001) y la ORIF de la clavícula (ATET=16,16; p=0,028), el clavo intramedular de fémur (ATET=11,52; p=0,003), la reparación del manguito rotador (ATET=16,88; p<0,001), la discectomía parcial (ATET=10,52; p=0,001), la artroplastia total de rodilla (TKA) (ATET=5,69; p<0,001), la artroplastia total de cadera (THA) anterior (ATET=8,80; p<0,001), la THA lateral (ATET=7,02; p<0,001) y la hemiartroplastia de cadera no cementada (ATET=16,79; p=0,049).

Conclusión

La rotación intraoperatoria del personal de enfermería prolonga significativamente los tiempos quirúrgicos en las cirugías ortopédicas de hasta 3h de duración. Esto pone de relieve la importancia de desarrollar estrategias para evitar la rotación de enfermeras de quirófano durante las cirugías con el fin de mejorar la eficiencia del quirófano y reducir los costes sanitarios.

Palabras clave:
Eficiencia
Cirugía ortopédica
Quirófano
Enfermero/a instrumentista
Listas de espera quirúrgicas

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