Identification and use of operating room efficiency indicators: the problem of not performing the right search within PubMed.

Drs. Fixler and Wright should be commended for demonstrating that operating room (OR) performance indicator definitions vary in literature and among children’s hospitals. Unfortunately, I do not agree with their conclusion that the most logical course would be for professional associations to agree upon and develop common metrics and definitions. Their conclusion is based on a limited review of papers that are not always relevant. First, the Procedural Times Glossary has been the leading source for OR definitions since 1997. Papers describing operational research in ORs use this glossary. A bibliography of papers concerning operational research within the OR can be found online (http://www .franklindexter .net /bibliography _TOC.htm). Based on this evidence, I conclude that there are clear definitions for monitoring OR performance indicators. An additional conclusion is that hospitals continue to use their own definitions. This needs to be solved by sending surgeons, anesthesiologists and managers of ORs to courses where they can learn which indicators to use and how to use them. Fixler and Wright call for us to use the OR resources in both an efficient and effective way. Here they make a mistake. Indeed, monitoring the operational performance of the OR may contribute to the use of OR resources in an efficient way. However, the call to use OR resources in an effective way is a faulty statement. According to the Institute of Medicine’s Committee on Quality Health Care in America, effective care “is based on providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively).” Here the patient clinical parameters are of interest and not, for example, the utilization rate of the OR. In conclusion, performing an accurate search in PubMed will show that the actual problem of agreed-upon definitions in literature, as described by the authors, does not exist.