Impact of Staffing on Peri-Operative Surgical Quality

Rosalie Tocco-Bradley, PhD, MD, MHSA

Chief Clinical Officer, Trinity Health Michigan

Date: April 2025

Workforce in the Perioperative Environment – not just nurses!

• Preop/PACU Nurses

• OR nurses (often specialty specific)

• Surgery Technicians (scrub tech)

• CRNA’s and Anesthesia Assistants

• Anesthesiologists

• Central Sterile Processing technicians

• EVS (environmental services)

• Anesthesia technicians

• Rad techs, Pharmacists, perfusionists

• APPs (Advanced Practice Professionals = PAs and NPs

• Surgeons

In 2025, expected to be short over 80,000 nurses and 42/50

States will remain short in 2030

Jessica Lyons

Nurse.org publication

Despite ongoing nursing shortage, 70,000 qualified applicants

continue to be turned away from nursing school programs

Nursegrid.com

By Zach Smith, BSN, RN

Turnover of Surgery Techs, Surgery RNs and Central

Sterile Procedure Techs (THMI)

Operating Room

Surgery Techs

Central Sterile

Processing

First Year Turnover

38.3%

42.9% 43.2%

90 day turnover

46.7%

55.6% 14.3%

Voluntary turnover

9.2%

13.3% 15.9%

Orientation timeline

9 – 12 months

9 months 3 – 6 months

Physician shortage projected at 124,000 by 2025

Projected surgeon shortages predicted by 2050: general

surgeons projected to by > 25,000 short

Surgery Specialty Distribution Over 65 years & under 40 years

Physician Workforce Data 2024

American College of Surgeons

Anesthesia workforce diminishing in the perioperative space as

providers age and there is an increasing demand in not only the

inpatient OR’s but also endoscopy, cath lab, IR, & ASC’s

Factors which are outweighing demand for anesthesia Providers

over actual supply

• Serious safety events periop

• Sub-specialty OR nursing teams compromised

• Central sterile processing errors

• Preoperative patient prep e.g. ERAS and medications

• Surgical site infections

• Operational KPIs – on time starts, room turnover

• Nurses need to practice at the top of their license

• PACU congestion & holds

• OSHA related injuries – sharps & safe patient movement

How is quality of care & safety affected by staffing shortages,

staff turnover, agency staff and aging staff? CONSIDER:

Univ St. Augustine for Health Sciences

Nursing Shortage: 2024 Data Study

• Physical admission, weighing and bedding

• Epic intake – history & med reconciliation

• Confirm bowel prep, oral Abx, carbohydrate load

• Chlorhexidine wipes

• Oral meds – Tylenol, Celecoxib, Alvimopan

• Place IV lines

• Glucose POC (and other relevant labs)

• IV meds to bedside – Kefzol, Flagyl

• Nurse sedation to assist Anesthesia blocks (TAP or Epidural)

• Active warming with Bair Hugger

• Other special considerations

Example of Nursing tasks for Colorectal Enhanced Recovery

Protocol – consider prepping 2 simultaneous patients and

distractions which ensue

Patient & colleague safety further comprised by staffing shortages

AHRQ: Agency for Healthcare Research & Quality 2023

Safety Event Classification Pyramid

Safety Event Classification Levels of Harm

SSE categories: Example of a One Year Summary

Medication Error: Insulin administration

Mismanaged specimens or lost specimens

• Intraop team communication and

nursing and scrub tech

experience key

• Specimen handoff

• Read back during hand over

process including name, type,

location of retrieval

• Appropriate handling of

specimen

• Transport to lab

• Lab management

• Retained foreign bodies (e.g. sponge or clip)

• Wrong procedure or wrong side procedure

• Surgical site infection - not adhering to strict infection

prevention protocols

• Delayed response to patient exhibiting hypotension or

hypoxia due to alarm fatigue or absent alarms (preop and

PACU)

• Contaminated sterile packs

• Empty oxygen tank

Other perioperative events which should be never events

Five Ways to Ease Staffing Shortages Now and into the Future

(per American Hospital Association)

1. Customize retention strategies

2. Lean more on advanced practice nurses and LPN

teams

3. Strive to become a Millennial/Gen Z Destination

4. Integrate workforce planning with strategic planning

5. Create your own solutions

American Hospital Association 2024

More specific strategies for improving OR staffing & workload

• Align with colleges, universities and tech schools

• Sponsored education programs at schools

• Registered apprentice programs for surgery techs in your hospital

• In house training of CSP technicians

• Aggressive recruitment strategies

• Posting broadly including Linkendin

• Local school campaigns

• Flexible scheduling – meet work life balances

• Add nursing techs and assure that EVS & transport support OR areas so

that nurses can provide top of license work

• Overlap of night and day shift to launch first case starts

And finally….continue to stress safety behaviors and tools at daily

huddles and educational sessions