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Background Turnover time (TOT)—the interval between one patient exiting and the next entering the same operating room (OR)—is a key determinant of surgical efficiency. While industry benchmarks suggest a baseline of 30-40 min TOT for most surgical subspecialties, neurosurgery presents unique challenges due to procedural complexity and specialized equipment requirements. Extended turnover times can disrupt perioperative workflows, delay case start times, and decrease potential revenue as OR operational costs range from US$30-100 per minute. This study aims to identify modifiable drivers of prolonged neurosurgical TOT and propose data-driven interventions.
Methods We conducted a mixed-methods study analyzing 1,232 neurosurgical turnovers at a high-volume academic hospital. A linear mixed-effects model was used to assess the influence of factors including inpatient versus outpatient status, procedure type, and temporal variables (day and month). Semi-structured interviews with perioperative staff and administrators (n=18) and direct OR observations were conducted to triangulate findings.
Results Mean TOT was 58.9 minutes (SD = 13.1 minutes), with inpatient status adding 8.6 minutes (p<0.001). Complex procedures (e.g., spine tumor) averaged over 65 minutes, yet the 25th percentile within those categories achieved TOTs 9.6 minutes shorter than average—demonstrating that there is room for TOT improvement even for high-complexity cases. Stakeholders cited delayed patient transport, equipment readiness, and poor team coordination as recurrent issues. Electronic health record alert failures and inconsistent staffing compounded delays. Stakeholders also stressed the critical importance of aligning incentives and transparent accountability across services to ensure all personnel are motivated to achieve more efficient turnovers while maintaining regulatory compliance. Interviewees viewed the 30-minute target as unrealistic for neurosurgery.
Conclusion TOT drivers are multifactorial, stemming from poorly coordinated patient flow, equipment setup inefficiencies, and fragmented intra-team communication. Next steps include piloting OR dashboards with real-time alerts, implementing role-specific turnover checklists, and setting tailored benchmarks by procedure type. Modeling interventions on the most efficient turnovers could reclaim OR time, reduce overtime costs, and improve team workflow without compromising safety.
