[Improving operating room efficiency: an observational and multidimensional approach in the San Camillo-Forlanini Hospital, Rome].

AIM: The management of operating rooms (ORs) is a complex process which requires an effective organizational scheme. In order to amore convinient allocation of resources a rigorous monitoring plan is needed to ensure operating rooms performances. All the necessary actions should be taken to improve the quality of the planning and scheduling procedure. RISULTATI: Il percorso prodotto (asis) ha permesso di descrivere i tempi per le attivita relativi alla logistica inbound. Sia per il BOE che per la CCH le attivita settimanali con maggiore impegno temporale sono state la verifica e lo stoccaggio dei farmaci e dei presidi (130[DS=±14] per la prima e 30[DS=±18] per la seconda). I tempi medi di allestimento sala, calcolati separatamente per il primo intervento erano di 27 (SD = ± 17), e per gli interventi successivi di 15 (SD=± 10), ove si evidenzia una differenza significativa di 12 minuti tra i due tempi. In CCH si segnala una elevata variabilita dei tempi rilevati per queste operazioni (CV= 82%). L’outcome del percorso prodotto, attraverso la prospettiva degli stakeholders, ha fatto emergere discreti valori medi di soddisfazione degli infermieri, dei chirurghi (2.9 vs 2.3) degli anestesisti (2.8 BOE vs 2.4 CCH). Il fattore “trasporto da un padiglione esterno” ha influenzato negativamente la percezione dei pazienti: i tempi sono risultati nettamente ridotti per coloro che afferivano alla CCH rispetto al BOE. I risultati del percorso sicurezza hanno fatto emergere una moderata criticita sia in relazione al riordino a fine seduta operatoria, sia in relazione al ritardo dell’inizio del primo intervento programmato. RESULTS: The asis approach allowed us to describe the ORs inbound activities. For both operating block the most demanding weekly commitments in terms of time turned out to be the inventory management procedures of controlling and stocking medicines, general medical supplies and instruments (130[DS=±14] for BOE and 30[DS=±18] for CCH. The average time spent on preparing the operating room, separately calculated starting from the first surgical case, was of 27 minutes (SD=± 17) while for the following surgical procedures preparation time decreased to 15 minutes (SD= ± 10), which highlighted a meaningful difference of 12 minutes. A great variability was registered in CCH due to the unpredictability of these operations (CV 82%). The stakeholders' perspective revealed a reasonable level of satisfaction among nurses and surgeons (2.9 vs 2.3, respectively) and in anesthesiologist (2.8-BOE vs 2.4 CCH).Being brought to the surgical suite from an "external Unit" seems to have negatively influenced the patient's perception: preparation time turned out to be significantly lower for CCH patients rather than BOE ones (p˂0,001).The results of the safety procedure approach highlighted a moderate criticality in terms of cleaning up time and delay in the starting time of the first surgical case. CONCLUSION: More effort should be made to avoid any slowdown during the whole process. It is advisable to implement a lean system that may improve efficiency and quality of the service to reduce wastes and unproductive times. This would inevitably generate a more positive outcomes.