Introduction to the Operation Room Management technology: Interrupted Time Series analysis in an urban acute care hospital facility in Rome, Italy

Introduction to the Operation Room Management technology: Interrupted Time Series analysis in an urban acute care hospital facility in Rome, Italy

Authors

  • Mattia Marte Local Health Authority ASL Roma 1, Rome, Italy
  • Gaia Piunno Post-Graduated School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
  • Giuseppe Furia Local Health Authority ASL Roma 1, Rome, Italy; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
  • Antonio Vinci Local Health Authority ASL Roma 1, Rome, Italy; Doctoral School in Nursing Sciences and Public Health, University of Rome Tor Vergata, Rome, Italy
  • Fabio Ingravalle Doctoral School in Nursing Sciences and Public Health, University of Rome Tor Vergata, Rome, Italy; Local Health Authority ASL Roma 6, Albano Laziale (Rome), Italy
  • Stefano Ungaro Post-Graduated School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy
  • Dorian Bardhi Hospital Management, Azienda Ospedaliero Universitaria, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
  • Gennaro D'Agostino Local Health Authority ASL Roma 1, Rome, Italy
  • Patrizia Chierchini Local Health Authority ASL Roma 1, Rome, Italy
  • Corrado De Vito Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
  • Massimo Maurici Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy

Keywords:

Hospital Management, Operating Room, Surgery, Time Series Analysis, Health Technology Assessment

Abstract

Background. The surgical pathway represents a fundamental process in hospital productivity, and its digitalization is a major focus for hospital management. ASL Roma 1 health authority has taken up this digitalization challenge by introducing an Operation Room Management (ORM) system within the operating block of one of its hospital facilities in 2022.
Study Design. Interrupted Time Series analysis.
Methods.To evaluate the impact of Operation Room Management system adoption, data on surgery were collected from all inter- ventions performed during two periods: January-June 2019 and January-June 2023. Analysis of the Operation Room Management system utilization rate since its introduction was performed, to estimate staff adaptation to the new software.
Results. As of June 2023, paper-registered interventions were 9%, nearing 100% for elective procedures only. The difference between the average intervention times was significantly in favor of the Operation Room Management cohort when restricting the analysis to Orthopedics (-9.02 minutes, p=0.006) and Surgery (8.47 min, p = 0.03). There was a modest but significant impact of Operation Room Management on the ‘entering Operation Room to Incision’ time (5 min, p < 0.01).
Conclusion. Overall, the adoption of the Operation Room Management did not worsen process outcomes. Operation Room Mana- gement offers advantages in real-time data quality, integrated with territorial and hospital platforms, contributing to a favorable cost-benefit assessment of digitalization.

References

1. World Health Organization (WHO). Global strategy on digital health 2020-2025 [Internet]. 2021. Available from: https://www.who.int/docs/default-source/documents/gs4dh-daa2a9f352b0445bafbc79ca799dce4d.pdf [Last accessed: 2024 Jul 10].

2. Filomena P, Sebastian K, Kati K, Tiffany L, Ismael SC; EFIM Telemedicine, Innovative Technologies and Digital Health Working Group. Telemedicine in internal medicine: A statement by the European Federation of Internal Medicine. Eur J Intern Med. 2023 Jun;112:138-139. doi: 10.1016/j.ejim.2023.02.021. Epub 2023 Mar 3. PMID: 36872139.

3. Casella G, Ingravalle F, Ingravalle A, Monti C, Bonetti F, Limonta A. COVID emergency: an opportunity to increase the interaction between hepatologist and primary care physician. Minerva Gastroenterol Dietol. 2020 Dec;66(4):328-330. doi: 10.23736/S1121-421X.20.02713-0. Epub 2020 Jun 2. PMID: 32492995.

4. Pietrantonio F, Vinci A, Rosiello F, Alessi E, Pascucci M, Rainone M, et al. Green Line Hospital-Territory Study: A Single-Blind Randomized Clinical Trial for Evaluation of Technological Challenges of Continuous Wireless Monitoring in Internal Medicine, Preliminary Results. Int J Environ Res Public Health. 2021 Sep 30;18(19):10328. doi: 10.3390/ijerph181910328. PMID: 34639631; PMCID: PMC8507826.

5. Pietrantonio F, Bussi AR, Amadasi S, Bresciani E, Caldonazzo A, Colombini P, et al. Technological Challenges set up by Continuous Wireless Monitoring designed to Improve Management of Critically Ill Patients in an Internal Medicine Unit (LIMS study): Study Design and Preliminary Results. J Community Prev Med. 2019;2(1):1-7. doi: 10.33309/2638-7719.020104.

6. Sandhu HS, Smith RW, Jarvis T, O’Neill M, Di Ruggiero E, Schwartz R, et al. Early Impacts of the COVID-19 Pandemic on Public Health Systems and Practice in 3 Canadian Provinces From the Perspective of Public Health Leaders: A Qualitative Study. J Public Health Manag Pract. 2022 Nov-Dec 01;28(6):702-711. doi: 10.1097/PHH.0000000000001596. Epub 2022 Aug 26. PMID: 36027605; PMCID: PMC9528938.

7. DeRiso B, Cantees K, Watkins WD. The operating rooms: cost center management in a managed care environment. Int Anesthesiol Clin. 1995 Fall;33(4):133-50. PMID: 8964622.

8. Agarwal R, Green R, Agarwal N, Randhawa K. Benchmarking management practices in Australian public healthcare. J Health Organ Manag. 2016;30(1):31-56. doi: 10.1108/JHOM-07-2013-0143. PMID: 26964848.

9. Rosko M, Al-Amin M, Tavakoli M. Efficiency and profitability in US not-for-profit hospitals. Int J Health Econ Manag. 2020 Dec;20(4):359-379. doi: 10.1007/s10754-020-09284-0. Epub 2020 Aug 20. PMID: 32816192; PMCID: PMC7439627.

10. Saporito A, La Regina D, Perren A, Gabutti L, Anselmi L, Cafarotti S, et al. Contribution margin per hour of operating room to reallocate unutilized operating room time: a cost-effectiveness analysis. Braz J Anesthesiol. 2023 May-Jun;73(3):243-249. doi: 10.1016/j.bjane.2021.03.024. Epub 2021 Apr 27. PMID: 33930345; PMCID: PMC10240232.

11. Krupka DC, Sandberg WS. Operating room design and its impact on operating room economics. Curr Opin Anaesthesiol. 2006 Apr;19(2):185-91. doi: 10.1097/01.aco.0000192795.64678.e7. PMID: 16552226.

12. von Schudnat C, Schoeneberg KP, Albors-Garrigos J, Lahmann B, De-Miguel-Molina M. The Economic Impact of Standardization and Digitalization in the Operating Room: A Systematic Literature Review. J Med Syst. 2023 May 2;47(1):55. doi: 10.1007/s10916-023-01945-0. PMID: 37129717.

13. Barbagallo S, Corradi L, de Ville de Goyet J, Iannucci M, Porro I, Rosso N, et al. Optimization and planning of operating theatre activities: an original definition of pathways and process modeling. BMC Med Inform Decis Mak. 2015 May 17;15:38. doi: 10.1186/s12911-015-0161-7. PMID: 25982033; PMCID: PMC4436841.

14. Asafo-Adjei E, Qabhobho T, Adam AM. Conditional effects of local and global risk factors on the co-movements between economic growth and inflation: Insights into G8 economies. Heliyon. 2023 Aug 31;9(9):e19570. doi: 10.1016/j.heliyon.2023.e19570. PMID: 37809407; PMCID: PMC10558848.

15. Ravaioli M, Pinna AD, Francioni G, Montorsi M, Veneroni L, Grazi GL, Palini GM, Gavazzi F, Stacchini G, Ridolfi C, Serenari M, Zerbi A. A partnership model between high- and low-volume hospitals to improve results in hepatobiliary pancreatic surgery. Ann Surg. 2014 Nov;260(5):871-5; discussion 875-7. doi: 10.1097/SLA.0000000000000975. PMID: 25243551.

16. Quercioli C, Cevenini G, Messina G, Carta GA, Becattini G, Sancasciani S. Reducing waiting times of elective surgical procedures: effectiveness evaluation of a multi-interventions approach. Ann Ig. 2022 Nov-Dec;34(6):635-649. doi: 10.7416/ai.2021.2495. Epub 2022 Jan 25. PMID: 35060992.

17. Vinci A, Furia G, Cammalleri V, Colamesta V, Chierchini P, Corrado O, et al. Burden of delayed discharge on acute hospital medical wards: A retrospective ecological study in Rome, Italy. PLoS One. 2024 Jan 24;19(1):e0294785. doi: 10.1371/journal.pone.0294785. PMID: 38265995; PMCID: PMC10807762.

18. Turatto F, Sassano M, Goletti M, Severoni S, Grossi A, Parente P. Ensuring Equitable Access to the COVID-19 Vaccine: The Experience of A Local Health Unit in Rome, Italy. Healthcare (Basel). 2022 Nov 10;10(11):2246. doi: 10.3390/healthcare10112246. PMID: 36360587; PMCID: PMC9690205.

19. Furia G, Vinci A, Colamesta V, Papini P, Grossi A, Cammalleri V, et al. Appropriateness of frequent use of emergency departments: A retrospective analysis in Rome, Italy. Front Public Health. 2023 Apr 4;11:1150511. doi: 10.3389/fpubh.2023.1150511. PMID: 37081951; PMCID: PMC10110884.

20. Reichert M, Sartelli M, Weigand MA, Doppstadt C, Hecker M, Reinisch-Liese A, et al; WSES COVID-19 emergency surgery survey collaboration group. Impact of the SARS-CoV-2 pandemic on emergency surgery services-a multinational survey among WSES members. World J Emerg Surg. 2020 Dec 9;15(1):64. doi: 10.1186/s13017-020-00341-0. PMID: 33298131; PMCID: PMC7724441.

21. Pietrantonio F, Rosiello F, Alessi E, Pascucci M, Rainone M, Cipriano E, et al. Burden of COVID-19 on Italian Internal Medicine Wards: Delphi, SWOT, and Performance Analysis after Two Pandemic Waves in the Local Health Authority “Roma 6” Hospital Structures. Int J Environ Res Public Health. 2021 Jun 3;18(11):5999. doi: 10.3390/ijerph18115999. PMID: 34204972; PMCID: PMC8199852.

22. Huy NT, Chico RM, Huan VT, Shaikhkhalil HW, Uyen VNT, Qarawi ATA, et al; contributors of the TMGH-Global COVID-19 Collaborative; TMGH-Global COVID-19 Collaborative. Awareness and preparedness of healthcare workers against the first wave of the COVID-19 pandemic: A cross-sectional survey across 57 countries. PLoS One. 2021 Dec 22;16(12):e0258348. doi: 10.1371/journal.pone.0258348. PMID: 34936646; PMCID: PMC8694437.

23. Vinci A, Pasquarella A, Corradi MP, Chatzichristou P, D’Agostino G, Iannazzo S, et al. Emergency Medical Services Calls Analysis for Trend Prediction during Epidemic Outbreaks: Interrupted Time Series Analysis on 2020-2021 COVID-19 Epidemic in Lazio, Italy. Int J Environ Res Public Health. 2022 May 13;19(10):5951. doi: 10.3390/ijerph19105951. PMID: 35627487; PMCID: PMC9140838.

24. Reichert M, Sartelli M, Weigand MA, Hecker M, Oppelt PU, Noll J, et al; WSES COVID-19 emergency surgery survey collaboration group. Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members. World J Emerg Surg. 2022 Jun 16;17(1):34. doi: 10.1186/s13017-022-00424-0. Erratum in: World J Emerg Surg. 2022 Jul 8;17(1):39. doi: 10.1186/s13017-022-00442-y. PMID: 35710386; PMCID: PMC9202986.

25. Andreozzi V, Marzilli F, Muselli M, Previ L, Cantagalli MR, Princi G, et al. The impact of COVID-19 on orthopaedic trauma: A retrospective comparative study from a single university hospital in Italy. Orthop Rev (Pavia). 2021 Jan 28;12(4):8941. doi: 10.4081/or.2020.8941. PMID: 33585026; PMCID: PMC7874950.

26. Mastri P, Di Petrillo F, Cerone A, Muselli M, Saracco M, Logroscino G, et al. Reduction in the Duration of Postoperative Fever during the COVID-19 Pandemic in Orthopedic and Traumatic Surgery Due to PPE and Cautions. J Clin Med. 2022 Mar 16;11(6):1635. doi: 10.3390/jcm11061635. PMID: 35329961; PMCID: PMC8953353.

27. Barnea R, Voronenko L, Zu L, Reychav I, Weiss Y. Analyzing Operating Room Utilization in a Private Medical Center in Israel. Isr Med Assoc J. 2019 Oct;21(10):644-648. PMID: 31599503.

28. Skrivankova VW, Richmond RC, Woolf BAR, Yarmolinsky J, Davies NM, Swanson SA, et al. Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization: The STROBE-MR Statement. JAMA. 2021 Oct 26;326(16):1614-1621. doi: 10.1001/jama.2021.18236. PMID: 34698778.

29. Konttila J, Siira H, Kyngäs H, Lahtinen M, Elo S, Kääriäinen M, et al. Healthcare professionals’ competence in digitalisation: A systematic review. J Clin Nurs. 2019 Mar;28(5-6):745-761. doi: 10.1111/jocn.14710. Epub 2018 Nov 22. PMID: 30376199.

30. Marwaha JS, Raza MM, Kvedar JC. The digital transformation of surgery. NPJ Digit Med. 2023 May 31;6(1):103. doi: 10.1038/s41746-023-00846-3. PMID: 37258642; PMCID: PMC10232406.

31. Huang CW, Lay YC, Chiu CY, Jan PT, Chen YH. Key Strategies for Digital Transformation - A Non-medical Center Hospital in Taiwan as An Example. J Internet Technol. 2023 Mar;24(2):389-400. doi: 10.53106/160792642023032402017.

32. Valvano M, Fabiani S, Magistroni M, Mancusi A, Longo S, Stefanelli G, et al. Risk of colonoscopic post-polypectomy bleeding in patients on single antiplatelet therapy: systematic review with meta-analysis. Surg Endosc. 2022 Apr;36(4):2258-2270. doi: 10.1007/s00464-021-08975-0. Epub 2022 Jan 13. PMID: 35028736; PMCID: PMC8921031.

33. Carollo DS, Mullet AP, Hays AJ, Fitzgibbons SA, Nelkin HD, Raymond AP. Study to assess the impact of analytics software on operating room controlled substance management and drug diversion. Am J Health Syst Pharm. 2024 May 24;81(11):e322-e328. doi: 10.1093/ajhp/zxae013. PMID: 38456350.

34. Longo S, Altobelli E, Castellini C, Vernia F, Valvano M, Magistroni M, et al. Non-steroidal anti-inflammatory drugs and acetylsalicylic acid increase the risk of complications of diverticular disease: a meta-analysis of case-control and cohort studies. Int J Colorectal Dis. 2022 Mar;37(3):521-529. doi: 10.1007/s00384-021-04088-1. Epub 2022 Jan 30. PMID: 35094111.

35. Frieri G, Valvano M, Frassino S, Faenza S, Cesaro N, Amicucci G, et al. Prophylactic Treatment with Vedolizumab in the Prevention of Postoperative Recurrence (POR) in High-Risk Crohn’s Patients. J Clin Med. 2023 Apr 26;12(9):3130. doi: 10.3390/jcm12093130. PMID: 37176570; PMCID: PMC10179568.

36. Pietrantonio F, Vinci A, Maurici M, Ciarambino T, Galli B, Signorini A, et al. Intra- and Extra-Hospitalization Monitoring of Vital Signs - Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators. Sensors (Basel). 2023 Jun 7;23(12):5408. doi: 10.3390/s23125408. PMID: 37420575; PMCID: PMC10305521.

37. Pietrantonio F, Florczak M, Kuhn S, Kärberg K, Leung T, Said Criado I, et al. Applications to augment patient care for Internal Medicine specialists: a position paper from the EFIM working group on telemedicine, innovative technologies & digital health. Front Public Health. 2024 Jun 28;12:1370555. doi: 10.3389/fpubh.2024.1370555. PMID: 39005984; PMCID: PMC11239350.

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Published

2025-04-30

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Vol. 37 No. 2 (2025)

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Original research

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Copyright (c) 2025 Mattia Marte, Gaia Piunno, Giuseppe Furia, Antonio Vinci, Fabio Ingravalle, Stefano Ungaro, Dorian Bardhi, Gennaro D'Agostino, Patrizia Chierchini, Corrado De Vito, Massimo Maurici (Author)

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How to Cite

1.
Marte M, Piunno G, Furia G, et al. Introduction to the Operation Room Management technology: Interrupted Time Series analysis in an urban acute care hospital facility in Rome, Italy. Ann Ig. 2025;37(2):255-265. doi:10.7416/ai.2025.2674