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Cutting Remarks: The OHIO Rule in the OR
Imagine surgical flow with fewer instrument exchanges.
John Kelly, IV
Publish Date: January 9, 2017   |  Tags:   Opinion
Only Handle It Once

Do cases take so long that the circulator keeps a diary? Does the turnover time allow for naps? If so, you need to send your surgeons and staff to OHIO, which stands for Only Handle It Once. Noted psychiatrist Edward Hallowell, MD, popularized this time-saving principle in a Harvard Business Review article, "Overloaded Circuits: Why Smart People Underperform" (osmag.net/rhgsr9).

Act on it, file it or throw it away
Think of ways you can apply the OHIO principle to both work and home. When you encounter an object or matter that requires action, handle the object only once until the task is completed — right then and there, without delay. For example, at home, when picking up your mail from the mailbox, sort out the junk mail and dispose of it outside your house into the trash once and for all. Don't sift through the envelopes only to put them down and revisit them again. Your aim is to handle the junk once so it won't require further action. When opening the mail, don't open envelopes and place them aside only to get to them later. Once you open the letter, do 1 of 3 things: act on it, file it or throw it away. No piles — they grow like weeds. Shuffling less paper will save you hours over the course of a month (you'll also pay your bills on time!).

The OHIO OR
The OHIO principle is especially effective in surgery. Robert E. Booth, MD, noted knee surgeon and efficiency master, conveyed the OHIO mindset to me years ago. Dr. Booth recognized how much time we waste in the OR when we pass instruments back and forth during the course of a case. What if, he wondered, we only handled each instrument once? We'd minimize instrument exchanges and save lots of time. When Dr. Booth performs a knee arthroplasty, he employs the periosteal elevator and the electrocautery and the saw blade only once. There's no time wasted with redundant instrument handoffs. OHIO (and skill) let Dr. Booth execute surgeries in hyper-efficient fashion.

As an arthroscopist, I apply OHIO whenever possible. In the past, when I performed an arthroscopic rotator cuff repair, I used a shaver blade to resect the subacromial bursa and decorticate the greater tuberosity. After the bursectomy, I would customarily exchange the shaver for a burr in order to perform the acromioplasty, and then return to the shaver for more tuberosity preparation. With the OHIO principle, I now use the shaver blade once — for all its necessary applications. I simply resect the bursa, then immediately proceed to the tuberosity before I introduce the burr.

Imagine the diminished transactions and handoffs resulting from implementation of OHIO. Cases will start to flow more lyrically and be completed in less time. An added bonus of fewer instrument exchanges: less occasion for error and sharps injuries. The discipline of applying OHIO to your life will result in more time, less clutter and the increased satisfaction of knowing that you completed tasks in timely fashion. Now where did I put that letter from Publishers Clearing House. I may already be a winner! OSM

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