Discovering the barriers to efficient robotic operating room turnover time: perceptions vs. reality

  • Tara N. CohenEmail author
  • Jennifer T. Anger
  • Kevin Shamash
  • Kate A. Cohen
  • Yosef Nasseri
  • Sarah E. Francis
  • Maureen Fimpler
  • Raymund Avenido
  • Bruce L. Gewertz
  • Daniel Shouhed
Original Article


Turnover time (TOT) has remained the subject of numerous research articles and operating room (OR) committee discussions. Inefficiencies associated with TOT are multiplied when complex technology, such as surgical robots, is involved. Using a human factors approach, this study investigated impediments to efficient robotic TOT and team members’ perceptions surrounding this topic. Researchers observed 20 robotic turnovers over 2 months at a tertiary hospital. TOT, cleaning time, number of staff present, bed set-up time, instrument set-up time and any major delays were recorded. Additionally, 79 OR team members completed a questionnaire regarding perceptions of OR turnover. Average TOT was 72 min (s, 24 min). Overall, cleaning required the most time (average of 27.4 min, 37.96% of TOT), followed by instrument set-up (15.4 min, 21.34% of TOT) and RN retrieval of the patient from pre-op (12 min, 17.72% of TOT). OR team members estimated that turnovers require 60.36 min. Physicians believed the greatest contributor to TOT was “time to set up the OR”, while OR staff rated “instrument availability” as the greatest issue, both of which were inaccurate. OR team members’ perceptions of robotic TOT and contributing factors were different from reality based on observed contributors. Data demonstrated several areas of opportunity for process improvement. These data can be used to guide the implementation of targeted interventions to improve TOT efficiency.


Human factors Robotic surgery Turnover time Quality improvement Operating room 



Operating room


Turnover time



No funding was received for this study.

Compliance with ethical standards

Conflict of interest

Jennifer Anger serves as an expert witness for Boston Scientific, Daniel Shouhed has received an Educational Honorarium from Intuitive, and Yosef Nasseri has received an honorarium from intuitive for being a key opinion leader. Tara N. Cohen, Kevin Shamash, Kate A. Cohen, Sarah E. Francis, Maureen Fimpler, Raymund Avenido, and Bruce L. Gewertz declare that they have no conflict of interest.

Authorship statement

The manuscript has been read and approved by all authors, each of whom contributed to the manuscript: Tara Cohen was responsible for study design, data collection, data analysis, manuscript writing and editing; Jennifer Anger was responsible for study design, data analysis and manuscript editing, Kevin Shamash was responsible for data collection, manuscript writing and editing, Kate Cohen was responsible for data collection, data analysis, manuscript writing and editing, Yoseph Nasseri was involved in the study design, data analysis and manuscript editing, Sarah Francis was responsible for study design, data collection and manuscript editing; Maureen Fimpler was involved with data collection, data analysis and manuscript editing; Ray Avenido was responsible for study design, and manuscript editing; Bruce Gewertz was responsible for study design and manuscript editing; and Daniel Shouhed was responsible for study design, data analysis, manuscript writing and manuscript editing.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Cedars-Sinai Institutional Review Board: #Pro00053956 and #Pro00053520) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2020

Authors and Affiliations

  • Tara N. Cohen
    • 1
    Email author
  • Jennifer T. Anger
    • 2
  • Kevin Shamash
    • 2
  • Kate A. Cohen
    • 1
  • Yosef Nasseri
    • 2
  • Sarah E. Francis
    • 2
  • Maureen Fimpler
    • 2
  • Raymund Avenido
    • 2
  • Bruce L. Gewertz
    • 2
  • Daniel Shouhed
    • 2
  1. 1.Department of SurgeryCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of SurgeryCedars-Sinai Medical CenterLos AngelesUSA

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