A systematic review of intraoperative process mapping in surgery.

Process mapping has been identified as a strategy to improve surgical efficiency but has been inconsistently applied in the literature and underutilised in surgical practice. In this journal, we recently described our utilisation of these approaches when applied to breast reconstruction. We showed that in surgery as complex as autologous breast reconstruction, process mapping can improve efficiency, and may improve surgical teaching, education and audit. The intraoperative period specifically is an area that can be applied not only to breast reconstruction, but to a much broader range of surgical procedures. A systematic review was undertaken of the databases Ovid MEDLINE, Allied and Complementary Medicine Database, Embase and PsychINFO. Manual searching of the references from articles identified was also conducted. Data items relating to the review aims were extracted from articles' methods, applications, and outcomes. A descriptive analysis was carried out to synthesise the information on the current usage of process mapping in the intraoperative period. Seventeen of 1,488 studies were eligible for review, with all of non-randomised study design. Studies had overlap in components of the intraoperative period to which process mapping was applied. Common areas of improvement were identified. Outcome measures were assessed in ten studies that implemented interventions based on the improvement areas to increase surgical efficiency. As such, process mapping has been used as part of larger quality improvement methods, albeit with inconsistent nomenclature, to improve surgical efficiency. While it has been applied to a range of surgical specialties, there is a lack of application to the surgical component of the intraoperative period. Greater consistency in the reporting and description of process mapping will enable further research for evidence of its benefits.