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How Can Hospitals Shorten Post-Surgery Stays?

Surgery team in operating room.

Anyone who has ever had surgery knows that the most important question for a patient, after the reassurance of a successful inpatient procedure, is how long it will take before returning home. While the performance of everyone on a surgical team is important, some roles play a greater part in how long a patient may need to remain at a hospital post-surgery.

New research looked at how the interaction between the core surgical team member, or the surgeon, and the non-core surgical team members, such as the circulator nurse, scrub tech and anesthesiologist, can affect team performance. Core members of teams lead, facilitate workflow and are central to problem solving. Non-core members play a vital role as well by bringing specialized skills essential to the task.  

“We looked at how dyadic experience between core and non-core surgical team members facilitated team performance,” said Lauren D’Innocenzo, PhD, an associate professor of Organizational Behavior at Drexel University’s LeBow College of Business, Provost Solutions Fellow and a co-author of the study. “Our findings could help hospitals optimize staffing in operating rooms for a more successful surgery and decrease the postoperative length of hospital stay.”

The researchers analyzed archival data from 7,070 surgeries at a large community hospital in the United States. From this data the researchers were able to compute how many times an individual surgeon had worked with non-core members on similar types of surgery. They then examined the time between surgery completion and patient discharge as a measure of team performance. According to the researchers, surgical team performance is often measured by length of hospital stay, with lower stay-times indicating higher performance.

They found that a surgeon’s prior experience with the rest of the surgical team played a vital role in the team’s performance such that if the surgeon had performed the same type of surgery with the same team members before, patient stays were shorter. However, the complexity of the surgery was a critical factor in this relationship. When the surgery was more complex (e.g., pulmonary bypasses), the surgeon’s prior experience with the non-core members of the team became less important. When the surgery was less complex (e.g., hernia repair), higher levels of prior experience together allowed the non-core team to better handle situations when the surgeon left the room.

“With this and other research we have done, we clearly see the benefits of shared experience has its limits,” said D’Innocenzo. “In highly complex tasks, shared experience with core members of the team becomes less important.”

When looking at the importance of the surgeon being physically in the operating room for complex surgeries, the researchers found that when the surgeon was present for most of the procedure, hospital stays decreased.

Surgeons typically work with the entire surgical team for about 60% of the surgery, with non-core members completing aspects of the surgery without the surgeon present. Findings indicated that the relationship between surgeon experience with non-core members and team performance was weakened when the surgery was more complex and when the surgeon spent less time in the operating room.

“Our research suggests that for complex surgeries, surgeons should make an effort to be present for as long as possible,” said D’Innocenzo.

For example, if the surgeon is present for 80% as opposed to 60% for all intermediate-level complexity procedures (e.g., gastric resections), then the patient would be expected to stay in the hospital for 1.86 days as opposed to 2.88 days. The researchers estimate this would save a hospital around $3.7 million annually. When the surgeon is present for the same amount of time for only 25% of all intermediate procedures, a hospital would still save almost $1 million, according to the researchers.

“With hospital inpatient care accounting for about 21% of all Medicare benefits payments and longer hospitals stays negatively affecting the quality of life for patients, considering dyadic core/non-core experience and the surgeon’s presence, has substantial implications,” said D’Innocenzo.

The paper, “The Room Where It Happens: The Impact of Core and Non-Core Roles on Surgical Team Performance,” is forthcoming in the Journal of Applied Psychology. Co-authors are Manuel Vaulont of Arizona State University; Jennifer Nahrgang of the University of Iowa; and Margaret Luciano and Carolyn Lofgren of Arizona State University. The research builds on a previous paper that examined the impact of shared team experiences on surgical team performance under routine and non-routine task conditions.

Media interested in speaking with D’Innocenzo should contact Niki Gianakaris, executive director of Media Relations, at ngianakaris@drexel.edu or 215-895-6741.

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