doortooperating

Door-to-operating, or door-to-OR time, is a medical performance metric used to evaluate how quickly a patient receives surgical intervention after arriving at a hospital. It measures the interval from a patient’s arrival at the emergency department or hospital (the door) to the start of an operative procedure in the operating room (the OR).

The metric is applied mainly to time-sensitive surgical emergencies where rapid intervention can affect outcomes, such as suspected internal bleeding, perforated abdominal viscus, ruptured vascular aneurysm, severe trauma, or appendicitis with signs of peritonitis. The exact endpoint can vary by protocol: some definitions use the start of the surgical incision, while others use the initiation of anesthesia or OR entry.

Several factors influence door-to-operating times. Preoperative stabilization, rapid diagnostic imaging and lab testing, preparation of anesthesia, availability of an on-call surgical team, and OR readiness all play roles. System-wide factors include hospital paging, OR scheduling, and interdepartmental coordination. Efficient DTO times are pursued as part of broader quality improvement programs to reduce delays in life-threatening situations.

Benchmarks and targets for door-to-OR time are not universal; they differ by condition, institution, and country. Some settings adopt specific time goals for particular emergencies, but many programs emphasize continuous improvement over a fixed standard. Evidence linking shorter DTO times to better outcomes is mixed and often context-dependent, requiring careful interpretation.

Limitations include variability in how DTO is defined, differences in patient triage, and the influence of prehospital care. DTO is one of several metrics used to assess emergency surgical care and to drive process improvements.