Minimizing overtime and improving operating room (OR) throughput are a constant challenge in our publicly funded healthcare system. Previous experience with Positive deviance sessions (PDS) identifying excelling individuals and disseminating their strategies leads to significant improvements in a tertiary care level institution. The purpose of this study is to utilize PDS to increase the chance of success for 4 joint-day completion in a smaller rural community hospital. PDS seminars were conducted for 13 OR nurses, 4 anesthetists and 2 arthroplasty orthopedic surgeons. Best performing staff shared strategies to enhance performance at PDS. Efficiency and agreement following use of these strategies was measured and discussed at future PDS. Success of 4 joint days is the primary outcome. Time from the patient in the room to anesthesia ready (anesthesia prep time = APT), from anesthesia ready to surgery start (surgery prep time = SPT), procedure length, from surgical finish to patient leaving the room (anesthesia finish time = AFT) and room turnover were recorded to determine best performers and effect of intervention. Data points were obtained prior to PDS, 1–5 months post PDS, and 9–13 months post PDS to represent sustainability of the intervention. Prior to PDS, 49% of total joint arthroplasty days were completed on time. At the two different time points post PDS, 81% and 80% were being completed on time respectively. Average time to complete 4 cases was reduced. Notable changes were made in anesthesia prep time (baseline 21 minutes, 17 minutes at the different time points), and turnover (baseline 30 minutes, 25 minutes at short term, 23 minutes at long term). Positive deviance sessions in the rural setting can result in increased success in completing 4 joint arthroplasty days with minimal associated costs identifying positive performers as well as stimulating local strategies for efficiency. Long term sustainability data involving an analysis of complications will determine any adverse events associated with this intervention.
Nucci et al. (Wed,) studied this question.