Improving operating room turnover efficiency with a real-time workflow coordination software in adult degenerative spine surgery

Background: Operating room (OR) efficiency represents a critical determinant of surgical productivity, cost-effectiveness, workforce wellness, and patient access to care. Among its modifiable components, turnover time (TOT), the interval between patient exit and subsequent patient entry, is a key target for operational improvement. This study describes the impact of the S1 Pit Crew™ platform, a real-time, role-based OR workflow coordination software, on TOT using adult degenerative spine surgery as a representative test environment.

Methods: This study examined prospectively collected perioperative and turnover workflow data from 51 consecutive elective adult degenerative spine surgery cases performed at a single hospital following S1 Pit Crew™ platform implementation. Baseline TOT was derived from institutional records of cases performed over the year preceding implementation and was used for descriptive comparison. The platform delivered real-time, role-specific task prompts and shared situational awareness across all perioperative team members via synchronized multi-device displays, enabling prospective collection of turnover and perioperative workflow data. A total of 24-time parameters were collected and aggregated into four key time interval durations including Stage 1: perioperative time interval #1 (dressing to wheels-out); Stage 2: turnover time (wheels-out to wheels-in); Stage 3: perioperative time interval #2 (wheels-in to incision); and total elapsed skin-to-skin time. Cases were stratified into initial (N=26) and subsequent (N=25) cohorts to assess efficiency with continued utilization and key time interval durations were also compared across procedure types, surgeon, OR, and case order.

Results: Mean TOT was 26.5 minutes following platform implementation, compared with a baseline institutional average of 38.0 minutes, representing a 30.3% descriptive difference. TOT decreased significantly between the initial (28.9±7.7 minutes) and subsequent cohort (23.9±3.7 minutes) (P=0.02). Perioperative time intervals did not differ significantly between initial and subsequent cohorts (P>0.05). All key time interval durations were similar across procedure types, surgeons, ORs, and case order (P>0.05).

Conclusions: After implementation of the S1 Pit Crew™ platform, mean TOT was descriptively 30.3% lower than the prior institutional baseline, with improvement observed with continued utilization and similar time durations across procedure types of varying complexity. Through standardizing workflow with real-time, shared task visibility, the platform functions as a behavioral coordination tool while also promoting accountability and enabling identification of inefficiencies. Real-time workflow coordination through the S1 Pit Crew™ platform may represent a scalable approach to improving OR efficiency across surgical environments.