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Novel combination of simulation and Lean methodology to improve operating room turnover
  1. Michael Meguerdichian1,
  2. Komal Bajaj2,
  3. Jessica Pohlman3,
  4. Vincent D'Orazio4,
  5. Katie Walker4,
  6. Adrienne Birnbaum5
  1. 1Department of Emergency Medicine, NYC Health+Hospitals/Harlem, New York, New York, USA
  2. 2Department of Obstetrics and Gynecology, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
  3. 3NYC Health+Hospitals/Simulation Center, Bronx, New York, USA
  4. 4NYC Health+Hospitals/North Central Bronx, Bronx, New York, USA
  5. 5Department of Emergency Medicine, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
  1. Correspondence to Dr Adrienne Birnbaum, Department of Emergency Medicine, NYC Health+Hospitals/Jacobi, 1B21 Building 6, 1400 Pelham Parkway South, Bronx, NY 10461, USA; adrienne.birnbaum{at}

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We describe a novel combination of medical simulation and Lean process improvement methodology applied to improve operating room (OR) turnover time (TOT). Excess OR TOT (time between one patient's exit and next patient's entry) negatively impacts throughput, patient care and revenue generation. Elimination of waste and improvement in efficiency are highly desirable.

Lean methodology, applied to healthcare, seeks improvement by eliminating waste, revising processes and identifying/resolving problems at a root-cause level.1–4 Staff are engaged in change through weeklong rapid improvement events (RIE) to redesign, test and implement new work processes. An RIE includes critical assessment of the current state, mapping current processes, identification of the desired state, examination of process gaps, brainstorming improvements and experimentation to develop solutions and improve standard work.1

To address the issue of excess OR TOT, taking an OR out-of-service would be disruptive to patient care and cost-prohibitive. A simulated OR provided a potential opportunity to rapidly and repeatedly recreate the turnover process, develop and practice standard work, experiment without patient harm/disruption of care and engage staff members in designing and implementing improvements by encouraging experimentation with change. To capture this opportunity, the perioperative services, hospital-wide process improvement and simulation centre teams collaborated.



The Institute for Medical Simulation and Advanced Learning (IMSAL) and Jacobi Medical Center (JMC), a municipal hospital, Bronx, New York, …

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  • Contributors All authors made substantial contributions to the conception and design of the work, manuscript revision and agree to be accountable for all aspects of the work. AB drafted the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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