Core competencies
Efficiency of the operating room suite

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Abstract

Background

The need to control high costs of running operating rooms while providing for timely patient care led us to assess the time wasted in the operating room (OR).

Methods

OR use by two general surgery and two orthopedic departments in a metropolitan public hospital were analyzed, and the time elapsed when a scheduled OR remained unused or the patient was still awaiting surgery was measured.

Results

OR “time-waste” defined as the time in which the scheduled OR was not busy with the scheduled patient amounted to 79 hours over the 30-day study period (15% of total time). It was wasted owing to inappropriately prepared patients (12%), unavailability of surgeons (7%), insufficient nursing staff, anesthesiologists, or OR assignment to emergency surgery (59%), congestion of the postanesthesia care unit (10%), and delay in transport to the OR (2%) Another issue delineated was the frequent occurrence of surgical cases running longer than their scheduled time (termed “spill-over”), outrunning the staffing expectations after 3:00 pm and delaying admission of add-on and emergency procedures, adding 33% to the time wasted. A quality-assurance committee review resulted in implementation of new guidelines, and within 3 months several underlying causes were rectified, and time-waste and spill over time was reduced by 35%. Surgical time predictions were also improved. Shortage of nurses and anesthesiologists, and OR emergency reassignment remained the major causes of OR waste time.

Conclusions

Continuous surveillance on OR suite—patients’ prompt care, repeated evaluation, and wise staff deployment—could maximize OR efficiency.

Section snippets

Methods

The study was performed prospectively in a surgical suite consisting of 10 ORs in a metropolitan teaching public medical center, and focused on two general surgery and two orthopedic departments that account for more than 70% of the surgical volume. It was conducted over 30 days that were randomly selected from 90 working days, excluding weekends and holidays. The study period also included on call days, in which the relevant departments were receiving all new emergency room admissions, thus

Phase 1, before intervention

A total of 814 operations were performed in the relevant period, on patients aged 63 ± 4 years, 42% of whom were male, and 72% of them took place in daytime shifts (7 am to 11 pm). The relative load on the two general surgery and two orthopedic departments was similar. Of these, 102 operations met the inclusion criteria that the surgery was scheduled but was not performed.

Overall, almost 79 hours were wasted, ie, almost three quarters of an OR’s working day each week, and they accounted for 15%

Comments

The frequent changes in resources, objectives, and methods of health provision in contemporary medical systems necessitate repeated assessment of all its aspects[1], [2]. The dictate to economize and the reality of reduced investment oblige hospitals, regardless of their economic autonomy, to provide the best possible and competitive health care services with increased efficiency.

The present study compared OR time nonutilization by two general surgery and two orthopedic departments that carry

References (16)

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