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Original research
Implementation of integrated operating rooms: how much time is saved and how do medical staff experience the upgrading? A mixed methods study in Denmark
  1. Kathrine Carstensen1,
  2. Emma Kejser Jensen1,
  3. Mads Lænsø Madsen2,
  4. Anne Marie Ladehoff Thomsen1,
  5. Claus Løvschall1,
  6. Nasrin Tayyari Dehbarez1,
  7. Bettina Wulff Risør1
  1. 1DEFACTUM, Central Denmark Region, Aarhus N, Denmark
  2. 2Department of Procurement & Clinical Engineering, Central Denmark Region, Aarhus, Denmark
  1. Correspondence to Dr Bettina Wulff Risør; bettriso{at}


Objectives To evaluate staff experiences of the implementation and use of integrated operating rooms (IORs) in comparison to conventional operating rooms (CORs) in Denmark.

Design This study used a mixed methods approach by combining quantitative (registry-based analysis of surgical time) and qualitative (interviews with experienced surgical staff) perspectives.

Setting Hospitals in Denmark.

Methods The quantitative component compared the time consumption of patients between the integrated and CORs in two hospital departments at Aarhus University Hospital. Data were extracted from the administrative system in the hospital. Independent t-tests were used to estimate the statistical differences in the mean time spent on patients between the two operating rooms (ORs), and linear regression was applied to adjust for the potential influence of the surgeon. The explorative qualitative research component involved interviews with 20 informants from 10 hospital departments across seven Danish hospitals, all of whom participated between February and April 2019. Data were analysed using thematic analysis.

Results The quantitative analyses showed that preparation time for lobectomy was significantly lower and completion time for cholecystectomy significantly higher in the integrated compared with CORs. No other statistically significant differences were found. The qualitative analysis showed that some nurses experienced better cooperation with the surgeon and that non-sterile nurses experienced an improved working environment in the integrated compared with CORs. Surgical staff experienced that the IORs led to improved workflow during surgery.

Conclusions This study identified no disadvantages regarding the use of IORs compared with CORs. The quantitative component of the research did not identify convincing statistically significant differences in the time consumption per patient between the ORs and according to the qualitative analyses IORs were not experienced by study participants to lead to major improvements among staff.

  • integrated operating room
  • technical equipment
  • surgical workflow
  • minimally invasive surgery

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  • Contributors KC developed the study, designed the qualitative data collection and planned and conducted interviews with clinical staff. She performed the qualitative analysis and contributed to drafting the manuscript. EKJ made substantial contributions to both the qualitative and quantitative data collection. She conducted interviews with clinical staff, and she performed the analyses and contributed to drafting the manuscript. MLM, AMLT, CL and NTD contributed to the conception and study design. They critically commented on the analyses and the manuscript. BWR developed the study, designed the quantitative data collection and planned the quantitative data collection. She performed the quantitative analysis and contributed to drafting the manuscript. All authors approved the final manuscript.

  • Funding The research was supported by Aarhus University Hospital and the five Danish regions.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The data collection for this study was registered and approved by the Danish Data Protection Agency (Journal no. 1-16-02-322-19). According to Danish law, this study did not require ethics approval from the National Committee on Health Research Ethics as it was an interview study and because the study did not involve personally sensitive information or human material. All informants/participants gave informed consent before taking part in the interviews.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The raw data represent confidential information and cannot be made public available according to the specific data license agreement (granted solely for the purpose of the project evaluation). The Stata software code is available upon request.

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