Surgical turnover efficiency analyses with combined use of FTA and FMEA approaches

This study introduces a methodology to comprehensively analyze and improve surgical turnover times, a critical factor in operating room efficiency and timely patient care. It proposes the combined use of Fault Tree Analysis (FTA) and Failure Mode and Effects Analysis (FMEA), two well-established reliability methodologies for complex system analysis and improvement, as an effective approach to identifying key causes that hinder operating room efficiency. To illustrate its potential, an observational, descriptive, and root-cause study was conducted in a tertiary hospital’s operating room unit. Primary data were collected over three months on surgical procedures, including causes of delays, cancellations, and rescheduling. Additionally, secondary data from 5,609 surgeries over one year were analyzed to identify systemic inefficiencies. The study confirmed the effectiveness of FTA and FMEA in identifying surgical turnover delay causes. For the unit studied, 58.3% of procedures exceeded the target turnover time of 20 min. FTA identified three main root causes: medical staff absenteeism, inpatient health-related events, and scheduling failures. FMEA prioritized strategies such as standardizing surgical times, enforcing surgeon contract compliance, pre-surgery patient monitoring, and implementing an automated scheduling system. The findings confirm many of the causes reported in the literature while providing a novel, systemic perspective on their inter-dependencies. This combined approach constitutes an “as-is diagnostic prioritization analysis,” which lies in the systematic identification, prioritization, and analytical characterization of critical failure modes affecting operating room bed management, thereby providing a robust evidence-based foundation for subsequent improvement initiatives.