Operating-room throughput: Strategies for improvement

Journal of Bone and Joint Surgery

Volumn 91, Issue 8, 2009, Pages 2028-2039

  Saleh, Khaled J ^a   Novicoff, Wendy M ^b   Rion, David ^b   MacCracken, Linda H ^c   Siegrist, Richard ^c  

^a SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF VIRGINIA HEALTH SYSTEM   (United States)

^c HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HUMAN; INTRAOPERATIVE PERIOD; OPERATING ROOM; OPERATING ROOM PERSONNEL; PATIENT CARE; POSTOPERATIVE PERIOD; PREOPERATIVE PERIOD; PRIORITY JOURNAL; RECOVERY ROOM; REVIEW; ARTICLE; ORGANIZATION AND MANAGEMENT; ORTHOPEDIC SURGERY; SAFETY;

EFFICIENCY, ORGANIZATIONAL; HUMANS; OPERATING ROOMS; ORTHOPEDIC PROCEDURES; SAFETY;

EID: 68349161179     PISSN: 00219355     EISSN: None     Source Type: Journal    
DOI: 10.2106/JBJS.H.01530     Document Type: Review

References (54)

1. National Center for Health Statistics. Health, United States, 2007 with chartbook on trends in the health of Americans. Hyattsville, MD: National Center for Health Statistics; 2007.
2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780-785
3. Bate A, Donaldson C, Ray H. Resource allocation in orthopaedics: economic evaluation to priority setting. Clin Orthop Relat Res. 2007;457:49-56. (Pubitemid 46573396)
4. Sandberg WS, Daily B, Egan M, Stahl JE, Goldman JM, Wiklund RA, Rattner D. Deliberate perioperative systems design improves operating room throughput. Anesthesiology. 2005;103:406-418 (Pubitemid 41076739)
5. Bozic KJ, Rosenberg AG, Huckman RS, Herndon JH. Economic evaluation in orthopaedics. J Bone Joint Surg Am. 2003;85:129-142
6. Overdyk FJ, Harvey SC, Fishman RL, Shippey F. Successful strategies for improving operating room efficiency at academic institutions. Anesth Analg. 1998;86:896-906. (Pubitemid 28177751)
7. Cendán JC, Good M. Interdisciplinary work flow assessment and redesign decreases operating room turnover time and allows for additional caseload. Arch Surg. 2006;141:65-70. (Pubitemid 43107391)
8. Christian CK, Gustafson ML, Roth EM, Sheridan TB, Gandhi TK, Dwyer K, Zinner MJ, Dierks MM. A prospective study of patient safety in the operating room. Surgery. 2006;139:159-173 (Pubitemid 43170315)
9. Harders M, Malangoni MA, Weight S, Sidhu T. Improving operating room efficiency through process redesign. Surgery. 2006;140:509-516 (Pubitemid 44442330)
10. Heslin MJ, Doster BE, Daily SL, Waldrum MR, Boudreaux AM, Smith AB, Peters G, Ragan DB, Buchalter S, Bland KI, Rue LW. Durable improvements in efficiency, safety, and satisfaction in the operating room. J Am Coll Surg. 2008;206:1083-1090 (Pubitemid 351620901)
11. Scheriff K, Gunderson D, Intelisano A. Implementation of an OR efficiency program. AORN J. 2008;88:775-789
12. Windle PE, Barron K, Walker D, Cormier J. A COMIT model utilization to improve first-case start time. Lippincotts Case Manag. 2001;6:38-46.
13. Torkki PM, Marjamaa RA, Torkki MI, Kallio PE, Kirvelä OA. Use of anesthesia induction rooms can increase the number of urgent orthopedic cases completed within 7 hours. Anesthesiology. 2005;103:401-405
14. Sokolovic E, Biro P, Wyss P, Werthemann C, Haller U, Spahn D, Szucs T. Impact of the reduction of anaesthesia turnover time on operating room efficiency. Eur J Anaesthesiol. 2002;19:560-563 (Pubitemid 34855558)
15. Krieg H, Schröder T, Grosse J, Hensel M, Volk T, von Heymann C, Bauer K, Bock RW, Spies CD. [Central induction area. Reduction of non-operative time without additional costs]. Anaesthesist. 2007;56:812-819 German.
16. Williams BA, Kentor ML, Williams JP, Figallo CM, Sigl JC, Anders JW, Bear TC, Tullock WC, Bennet CH, Harner CD, Fu FH. Process analysis in outpatient knee surgery: effects of regional and general anesthesia on anesthesia- controlled time. Anesthesiology. 2000;93:529-538
17. Armstrong KP, Cherry RA. Brachial plexus anesthesia compared to general anesthesia when a block room is available. Can J Anaesth. 2004;51:41-44
18. Breslin PT, Gale SO, Weitzner WM. Operational and design strategies for a reduced workforce. Healthc Financ Manage. 2003;57:62-65
19. Conrad DA, Sales A, Liang SY, Chaudhuri A, Maynard C, Pieper L, Weinstein L, Gans D, Piland N. The impact of financial incentives on physician productivity in medical groups. Health Serv Res. 2002;37:885-906. (Pubitemid 36125123)
20. Emery SE, Gregory C. Physician incentives for academic productivity. An analysis of orthopaedic department compensation strategies. J Bone Joint Surg Am. 2006;88:2049-2056 (Pubitemid 44352753)
21. Macario A, Horne M, Goodman S, Vitez T, Dexter F, Heinen R, Brown B. The effect of a perioperative clinical pathway for knee replacement surgery on hospital costs. Anesth Analg. 1998;86:978-984 (Pubitemid 28198862)
22. Coffey RJ, Richards JS, Remmert CS, LeRoy SS, Schoville RR, Baldwin PJ. An introduction to critical paths. Qual Manag Health Care. 1992;1:45-54.
23. Chalian AA, Kagan SH, Goldberg AN, Gottschalk A, Dakunchak A, Weinstein GS, Weber RS. Design and impact of intraoperative pathways for head and neck resection and reconstruction. Arch Otolaryngol Head Neck Surg. 2002;128:892-896 (Pubitemid 34856257)
24. Brenn BR, Reilly JS, Deutsch ES, Hetrick MH, Cook SC. 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
25. Macario A, Dexter F, Traub RD. Hospital profitability per hour of operating room time can vary among surgeons. Anesth Analg. 2001;93:669-675 (Pubitemid 32783294)
26. Dexter F, Blake JT, Penning DH, Lubarsky DA. Calculating a potential increase in hospital margin for elective surgery by changing operating room time allocations or increasing nursing staffing to permit completion of more cases: a case study. Anesth Analg. 2002;94:138-142, table of contents. (Pubitemid 34038734)
27. Sokal SM, Chang Y, Craft DL, Sandberg WS, Dunn PF, Berger DL. Surgeon profiling: a key to optimum operating room use. Arch Surg. 2007;142:365-370 (Pubitemid 46798428)
28. Becker S, Szabad M, Foltushansky S. Ambulatory surgery centers - current legal issues 2004 (Part 1). Health Care Law Mon. 2004:9-21.
29. Becker S, Szabad M, Foltushansky S. Ambulatory surgery centers - current legal issues 2004 (Part 2). Health Care Law Mon. 2004:3-10.
30. Glaser DM. Legal issues affecting ancillaries and orthopedic practice. Orthop Clin North Am. 2008;39:89-102, vii.
31. Memel SL, Grosvenor JC. The Stark II reality. Clin Orthop Relat Res. 2003;407:28-34.
32. Bridges M, Diamond DL. The financial impact of teaching surgical residents in the operating room. Am J Surg. 1999;177:28-32. (Pubitemid 29088993)
33. Babineau TJ, Becker J, Gibbons G, Sentovich S, Hess D, Robertson S, Stone M. The "cost" of operative training for surgical residents. Arch Surg. 2004;139:366-370
34. Farnworth LR, Lemay DE, Woolridge T, Mabrey JD, Blaschak MJ, DeCoster TA, Wascher DC, Schenck RC Jr. A comparison of operative times in arthroscopic ACL reconstruction between orthopaedic faculty and residents: the financial impact of orthopaedic surgical training in the operating room. Iowa Orthop J. 2001;21:31-35
35. Seymour NE, Gallagher AG, Roman SA, O'Brien MK, Bansal VK, Andersen DK, Satava RM. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002;236:458-464
36. McGowan JE, Truwit JD, Cipriano P, Howell RE, VanBree M, Garson A Jr, Hanks JB. Operating room efficiency and hospital capacity: factors affecting operating room use during maximum hospital census. J Am Coll Surg. 2007;204:865-872 (Pubitemid 46661206)
37. Chung F. Recovery pattern and home-readiness after ambulatory surgery. Anesth Analg. 1995;80:896-902.
38. Edler AA, Mariano ER, Golianu B, Kuan C, Pentcheva K. An analysis of factors influencing postanesthesia recovery after pediatric ambulatory tonsillectomy and adenoidectomy. Anesth Analg. 2007;104:784-789 (Pubitemid 46548298)
39. Dexter F, Macario A, Manberg PJ, Lubarsky DA. Computer simulation to determine how rapid anesthetic recovery protocols to decrease the time for emergence or increase the phase I postanesthesia care unit bypass rate affect staffing of an ambulatory surgery center. Anesth Analg. 1999;88:1053-1063 (Pubitemid 29211538)
40. Marcon E, Kharraja S, Smolski N, Luquet B, Viale JP. Determining the number of beds in the postanesthesia care unit: a computer simulation flow approach. Anesth Analg. 2003;96:1415-1423, table of contents. (Pubitemid 36512887)
41. Sokal SM, Craft DL, Chang Y, Sandberg WS, Berger DL. Maximizing operating room and recovery room capacity in an era of constrained resources. Arch Surg. 2006;141:389-395
42. Bhattacharyya T, Vrahas MS, Morrison SM, Kim E, Wiklund RA, Smith RM, Rubash HE. The value of the dedicated orthopaedic trauma operating room. J Trauma. 2006;60:1336-1341 (Pubitemid 43916607)
43. Elder GM, Harvey EJ, Vaidya R, Guy P, Meek RN, Aebi M. The effectiveness of orthopaedic trauma theatres in decreasing morbidity and mortality: a study of 701 displaced subcapital hip fractures in two trauma centres. Injury. 2005;36:1060-1066 (Pubitemid 41132798)
44. Wixted JJ, Reed M, Eskander MS, Millar B, Anderson RC, Bagchi K, Kaur S, Franklin P, Leclair W. The effect of an orthopedic trauma room on after-hours surgery at a level one trauma center. J Orthop Trauma. 2008;22:234-236
45. Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, Chong V, Fabri PJ, Gibbs JO, Grover F, Hammermeister K, Irvin G 3rd, McDonald G, Passaro E Jr, Phillips L, Scamman F, Spencer J, Stremple JF. The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg. 1998;228:491-507.
46. Khuri SF, Daley J, Henderson WG. The comparative assessment and improvement of quality of surgical care in the Department of Veterans Affairs. Arch Surg. 2002;137:20-27 (Pubitemid 34041814)
47. Young GJ, Charns MP, Daley J, Forbes MG, Henderson W, Khuri SF. Best practices for managing surgical services: the role of coordination. Health Care Manage Rev. 1997;22:72-81. (Pubitemid 127457373)
48. Young GJ, Charns MP, Desai K, Khuri SF, Forbes MG, Henderson W, Daley J. Patterns of coordination and clinical outcomes: a study of surgical services. Health Serv Res. 1998;33(5 Pt 1):1211-1236 (Pubitemid 29006386)
49. Healthcare Financial Management Association; McKesson Information Solutions. Comprehensive performance management in the operating room. Healthc Financ Manage. 2002;56:suppl 1-7 following 80.
50. Marco AP, Hart S. Cross-industry benchmarking: is it applicable to the operating room? Qual Manag Health Care. 2001;9:1-5.
51. Mosbacher K, Raeford D. Performance art: benchmarking OR efficiency. Mater Manag Health Care. 1999;8:20-22
52. Christian CK, Gustafson ML, Betensky RA, Daley J, Zinner MJ. The volume-outcome relationship: don't believe everything you see. World J Surg. 2005;29:1241-4. Erratum in: World J Surg. 2006;30:2085. (Pubitemid 41625966)
53. Khuri SF, Henderson WG. The case against volume as a measure of quality of surgical care. World J Surg. 2005;29:1222-1229
54. Kraus TW, Büchler MW, Herfarth C. Relationships between volume, efficiency, and quality in surgery - a delicate balance from managerial perspectives. World J Surg. 2005;29:1234-1240 (Pubitemid 41625965)