203 / 240
Weaknesses of this study include its retrospective nature
and the fluidity of a large surgical department. The ENT
service performed 287 more cases with 125 more turnovers
in the year following the implementation of TS than it did
the year prior. These differences may have served as con-
founding variables if there had been a significant change in
OR efficiency in either direction. However, since efficiency
was essentially the same, it is reasonable to assume that the
departmental changes were not masking TS effects.
Additionally, we began evaluating TS immediately after its
implementation and did not allow for a ‘‘washout’’ interval
while the health care team adjusted to the program. We
chose to start measuring efficiency changes immediately
after implementation because the providers had completed
extensive training before the program began, which should
have minimized the adjustment period. Nevertheless, there
may have been some initial decrease in efficiency due to
the process change in the OR. We did examine the effi-
ciency data for the first 6 months after TS implementation
(
Table 2
), and the intervals were very similar to those mea-
sured at 12 months, which supports the idea that there was
minimal washout effect.
Conclusion
TS did not lead to significant changes in efficiency within
the otolaryngology surgical service in the year after its
implementation. In fact, the ENT service at a major teach-
ing hospital was able to maintain its OR efficiency despite
adopting the rigorous TS patient safety initiative. Although
TS is a highly acclaimed evidence-based method improving
patient safety and teamwork, more study is needed to deter-
mine if it can decrease sentinel events and other preventable
medical errors.
Acknowledgments
We sincerely thank Ms Elizabeth Gessner for assistance with data-
base review.
Author Contributions
Alexandra Shams
, data collection and interpretation, drafted
manuscript, final approval, accountable for accuracy;
Mostafa
Ahmed
, data collection and statistical analysis, prepare and edit
manuscript, final approval, accountable for accuracy;
Nicholas J.
Scalzitti
, interpretation and analysis of data, preparation and edit-
ing manuscript, final approval, accountable for accuracy;
Matthew
Stringer
, data collection, data analysis, review and editing manu-
script, final approval, accountable for accuracy;
N. Scott Howard
,
data analysis and interpretation, review and editing manuscript,
final approval, accountable for accuracy;
Stephen Maturo
, study
design, data analysis, review and editing manuscript, final
approval, accountable for accuracy.
Disclosures
Competing interests:
None.
Sponsorships:
None.
Funding source:
None.
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