Decreased TJR scrub nurse hand-offs may maximize OR efficiency, reduce costs
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Intraoperative scrub nurse hand-offs during total hip and knee arthroplasty cases performed at a major, urban academic center were associated with increased OR times of as much as 18 minutes, based on results of a retrospective study.
Thomas R. Hickernell, MD, who presented the findings at the American Association of Hip and Knee Surgeons Annual Meeting, said, “There’s a lot of implications from this in terms of cost and patient outcomes. It’s a complex issue with a lot of variables and perhaps worth further investigation. This is something we could potentially take to our respective institutions to discuss staffing policies in order to maximize OR efficiency.”
From a chart review of 1,109 total knee arthroplasty patients and 1,032 total hip arthroplasty patients operated on from 2014 to 2018 by arthroplasty fellowship-trained orthopedic surgeons, Hickernell and colleagues collected the number of scrub nurse hand-offs, patient demographics, surgeon information and operative times.
The only confounder in terms of patient demographics researchers identified concerning scrub nurse hand-offs was an American Society of Anesthesiologists score of 3.8 to 4 among THA patients.
“We speculated this is probably because some of these patients are hip fracture patients undergoing THA” who are less optimized than elective THA cases and are operated on with an atypical OR crew, Hickernell said.
Regarding OR times, “Essentially almost every group, every variable, with just one scrub nurse hand-off saw associated increases in OR times,” which was statistically significant, he said.
For example, for THA, OR time increased 6 minutes for one hand-off and more than 18 minutes for two or more hand-offs, based on the multivariable linear regression analysis results.
“We were able to identify with total knees that one hand-off led to about a 4-minute increase in operative time, and two or more, it is a 16-minute increase,” Hickernell said.
Researchers noted there may be effects on orthopedic patient care and outcomes and OR efficiency that can be optimized by adopting scrub nurse staffing models that decrease intraoperative hand-offs.
“This time in the OR costs a lot of money and the longer the patient is in the OR, the higher the risk of, especially infection, complications,” Hickernell said.
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Hickernell TR, et al. Paper 47. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 5-8, 2020; Dallas (hybrid meeting).
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