Operating room design and its impact on operating room economics

Current Opinion in Anaesthesiology

Volumn 19, Issue 2, 2006, Pages 185-191

  Krupka, Dan C ^a   Sandberg, Warren S ^b  

^a Twin Peaks Group   (United States)

^b MASSACHUSETTS GENERAL HOSPITAL   (United States)

Author keywords

Operating room economics; Operating room efficiency; Operating room throughput; Performance improvement; Perioperative system design

Indexed keywords

ANESTHESIA INDUCTION; ANESTHESIST; COST EFFECTIVENESS ANALYSIS; HEALTH CARE COST; HEALTH CARE FACILITY; HEALTH CARE PERSONNEL; HEALTH ECONOMICS; HOSPITAL MANAGEMENT; HUMAN; MEDICAL TECHNOLOGY; NURSE ANESTHETIST; OPERATING ROOM; OPERATION DURATION; PATIENT TRANSPORT; PRIORITY JOURNAL; REVIEW; SYSTEM ANALYSIS; TASK PERFORMANCE;

FACILITY DESIGN AND CONSTRUCTION; HUMANS; OPERATING ROOMS; TERMINOLOGY;

EID: 33646070961     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.aco.0000192795.64678.e7     Document Type: Review

References (15)

1. Dexter F, Epstein RH, Traub RD, Xiao Y. Making management decisions on the day of surgery based on operating room efficiency and patient waiting times. Anesthesiology 2004; 101:1444-1453. A comprehensive review of operational decision making on the day of surgery to maximize operating room efficiency, with complete definitions of terms related to operating room management and references to quantitative work supporting the recommendations. Also includes useful information for calculating the financial impact of improving operating room efficiency.
2. Brenn BR, Reilly JS, Deutsch ES, et al. Analysis of efficiency of common otolaryngology operations: comparison of operating room vs short procedure room in a pediatric tertiary hospital. Arch Otolaryngol Head Neck Surg 2003; 129:435-437.
3. Dexter F, Macario A. Decrease in case duration required to complete an additional case during regularly scheduled hours in an operating room suite: a computer simulation study. Anesth Analg 1999; 88:72-76.
4. Lebowitz P. Schedule the short procedure first to improve OR efficiency. Aorn J 2003; 78 (4):651-654 (657-9).
5. Sokolovic E, Biro P, Wyss P, et al. Impact of the reduction of anaesthesia turnover time on operating room efficiency. Eur J Anaesthesiol 2002; 19: 560-563.
6. Hanss R, Buttgereit B, Tonner PH, et al. Overlapping induction of anesthesia: an analysis of benefits and costs. Anesthesiology 2005; 103:391-400. This study reports on an effort to move virtually all nonoperative activities directly related to the patient, including induction of anesthesia, patient positioning and emergence from anesthesia out of the operating room to ancillary spaces, supported by additional personnel, and running in parallel with operating room turnover (i.e. 'parallel processing'). The study is unique in that it drew on a pool of readily available inpatients, and so throughput was not limited by patient availability.
7. Sandberg WS, Daily B, Egan M, et al. Deliberate perioperative systems design improves operating room throughput. Anesthesiology 2005; 103: 406-418. This study demonstrated that parallel processing of nonoperative activities reduced the nonoperative time sufficiently to schedule additional cases during regular hours, to reduce overtime, or both, with additional revenue from the extra cases balancing the added costs. The test operating room and perioperative system was meant for continuous use, and the throughput improvement was sustained for the 14-month interval reported.
8. Torkki PM, Marjamaa RA, Torkki MI, et al. Use of anesthesia induction rooms can increase the number of urgent orthopedic cases completed within 7 hours. Anesthesiology 2005; 103:401-405. Another study demonstrating that parallel-processing operating room designs increase operating room throughput of patients scheduled for trauma surgery. In this example, the investigators accomplished one additional case per day in a single operating room.
9. Smith MP, Helfand R, Schubert A. QuEST operating room system decreases turnover time over 50% for hip and knee replacements. Anesthesiology 2005; 103:A1181. The authors developed a parallel-processing schema to establish spinal block for hip and knee replacement patients during operating room turnover, and to pass over care of the patient to a recovery room nurse sent to the operating room to collect the patient at the conclusion of surgery.
10. Friedman DM, Sokal SM, Chang Y, Berger DL. Increasing operating room efficiency through parallel processing. Ann Surg 2006; 243:10-14. This is an example of parallel processing of hernia repairs under regional anesthesia in which the block was performed in an adjacent holding area while the operating room was being turned over, rather than in the operating room after turnover. The surgeon was able to perform 1.5 days of cases in a single day, releasing operating room time to other surgeons.
11. Ferschl MB, Tung A, Sweitzer B, et al. Preoperative clinic visits reduce operating room cancellations and delays. Anesthesiology 2005; 103 (4):855-859. The authors demonstrated that carrying out a process step that is, (preoperative evaluation by an anesthesiologist) much earlier than the day of surgery reduced the cancellation rate on the day of surgery, both for ambulatory cases and for patients in the general operating room. The authors went on to show that advance preoperative evaluation decreased unused operating room time on the day of surgery.
12. Pakdil F, Harwood TN. Factors that influence efficiency in performing ENT cases: a qualitative and quantitative analysis. J Med Syst 2005; 29:285-301. In this study, a detailed analysis of workflow during turnovers led to the discovery that reprocessing of specialized surgical equipment between cases was contributing to turnover time. Additional equipment was purchased, reducing nonoperative time and generating extra operating room throughput.
13. Bromhead HJ, Jones NA. The use of anaesthetic rooms for induction of anaesthesia: a postal survey of current practice and attitudes in Great Britain and Northern Ireland. Anaesthesia 2002; 57:850-854.
14. ••]. The test operating room was capable of an additional two cases per day relative to operating rooms using the standard process, and the incremental cost of each additional case was much less than the average margin.
15. Dexter F, Coffin S, Tinker JH. Decreases in anesthesia-controlled time cannot permit one additional surgical operation to be reliably scheduled during the workday. Anesth Analg 1995; 81:1263-1268.