Improving OR efficiency in a university medical center arthroplastic surgery service.

Staff members in the arthroplastic surgery service at University of California San Francisco Medical Center initiated an multidisciplinary OR efficiency project at the request of the facility's chief executive officer and an arthroplastic surgeon. Elements of the program included forming a consistent team, updating preference cards, starting anesthesia care earlier in the day, working with sterile processing department personnel to improve case cart delivery, improving the turnover routine, and reducing and planning for surgery cancellations. Since the project began in 2004, the surgeon has been able to double his procedure volume in the same amount of time. The surgical team and the program have become an example for the medical center and have influenced the OR culture to focus on efficiency, quality, and accountability.