Operating room efficiency in a low resource setting: a pilot study from a large tertiary referral center in Ethiopia

Abstract Background The operating room (OR) is one of the most expensive areas of a hospital, requiring large capital and recurring investments, and necessitating efficient throughput to reduce costs per patient encounter. On top of increasing costs, inefficient utilization of operating rooms results in prolonged waiting lists, high rate of cancellation, frustration of OR personnel as well as increased anxiety that negatively impacts the health of patients. This problem is magnified in developing countries, where there is a high unmet surgical need. However, no system currently exists to assess operating room utilization in Ethiopia. Methodology A prospective study was conducted over a period of 3 months (May 1 to July 31, 2019) in a tertiary hospital. Surgical case start time, end time, room turnover time, cancellations and reason for cancellation were observed to evaluate the efficiency of eight operating rooms. Results A total of 933 elective procedures were observed during the study period. Of these, 246 were cancelled, yielding a cancellation rate of 35.8%. The most common reasons for cancellation were related to lack of OR time and patient preparation (8.7% and 7.7% respectively). Shortage of facilities (instrument, blood, ICU bed) were causes of cancelation in 7.7%. Start time was delayed in 93.4% (mean 8:56 am ± 52 min) of cases. Last case completion time was early in 47.9% and delayed in 20.6% (mean 2:54 pm ± 156 min). Turnover time was prolonged in 34.5% (mean 25 min ± 49 min). Total operating room utilization ranged from 10.5% to 174%. Operating rooms were underutilized in 42.7% while overutilization was found in 14.6%. Conclusion We found a high cancellation rate, most attributable to late start times leading to delays for the remainder of cases, and lack of preoperative patient preparation. In a setting with a high unmet burden of surgical disease, OR efficiency must be maximized with improved patient evaluation workflows, adequate OR staffing and commitment to punctual start times. We recommend future quality improvement projects focusing on these areas to increase OR efficiency.

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Causes and Effects of Inefficient Operating Room Flow during Working Hours in a University Hospital

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.09.9953 ◽

2020 ◽

Vol 103 (9) ◽

pp. 897-903

Keyword(s):

Operating Room ◽

Elective Surgery ◽

Tertiary Care ◽

Working Hours ◽

Turnover Time ◽

University Hospital ◽

Or Efficiency ◽

Average Delay ◽

First Case ◽

Cancellation Rate

Background: Operating rooms (ORs) are major source of both hospitals’ revenue and expenses; hence, OR efficiency is not only essential, but challenging for providing high-quality care, whilst utilizing limited resources. Materials and Methods: A prospective, observational study was conducted in a tertiary care university hospital to identify both causes and effects of inefficient OR flow, including the rate of first case tardiness, time delays while patients are in room, turnover time, cancellation rate, and OR-overutilization. Patients scheduled for elective surgery between September 2014 and February 2015 were recruited. Results: Three thousand nine hundred sixty-five elective surgical cases were recruited. The rate of first case tardiness was 48%. The average delay time of the first case was 25±16.6 minutes, with the main cause being late arrivals of surgical teams (97.4%). The rate of time delay while the patients were in room, was 73.2%. This is being associated with both the surgical and the anesthesia teams (83%), as well as positioning and procedures-related to the general anesthesia. The delay in turnover time was 12.9% with an average of 32.3±23.3 minutes, with most common causes being swapping of cases between ORs (22.7%) and delays in transferring patients from the ward (21.7%). The cancellation rate was 11.8%, with General surgery having the highest rate (15.5%) due to insufficient OR time (26.2%). Sixty-four-point-eight percent of the operations continued after working hours, with an average of 121.7±106.1 minutes (range 4 to 670 minutes). Conclusion: The present study identified five process points of OR inefficiency in a university hospital, demonstrating that there are substantial opportunities for enhancement of OR efficiency. Keywords: Efficiency, Operating room, First case, Tardiness, Cancellation, Turnover time, Utilization

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Organization of surgical services and operating room efficiency in Norwegian hospitals

Journal of Hospital Administration ◽

10.5430/jha.v2n2p61 ◽

2013 ◽

Vol 2 (2) ◽

pp. 61

Author(s):

Dag Bratlid ◽

Svein Petter Raknes

Keyword(s):

Operating Room ◽

Turnover Time ◽

Macro Level ◽

Organizational Strategies ◽

Operating Room Efficiency ◽

Or Efficiency ◽

Emergency Operations ◽

Surgical Services ◽

Micro Level ◽

Future Hospital

Background Most studies on operating room (OR) efficiency have focused on how local factors within the surgical facilities (micro level), such as turnover time, case duration and non-operative time, affects operating room efficiency. Few studies have analyzed how different strategies for organizing surgical services on the departmental or hospital level (macro level) might affect OR efficiency. Norwegian hospitals have organized their surgical services on the macro level along two different strategies. Most hospitals have separate facilities for out-patient surgery and in-patient surgery, often also geographically separated. Most hospitals also have specialty specific OR (orthopedics, gastroenterology, gynecology etc.), while in other hospitals different subspecialties share the same OR. This study was undertaken to analyze any effect of these different organizational strategies in relation to OR efficiency. Methods Data on organization of surgical services and operation volume for 2009 was gathered from eleven Norwegian university and larger county hospitals with a similar case mix. Total OR efficiency and OR efficiency during ordinary work hours were analyzed separately for out-patient and in-hospital surgery, including emergency operations. Calculation of OR during ordinary hours (8am-3pm) was based on 230 workdays per year, and included emergency operations. Results OR efficiency was 721 operations per OR per year with a range from 525 to 1049 and was not related to the different strategies for organizing these services. Furthermore, no correlation was found between OR efficiency and operation volume or number of OR. OR efficiency during ordinary hours and workdays was 3.6 operations per day for out-patient surgery and 1.8 for in-patient surgery including emergency operations. This was considerably less than standards used in planning surgical facilities in Norwegian hospitals. Conclusion OR efficiency is probably more related to organization of the surgical services on the micro level than to strategies for organizing these services on the macro level. The large variation in operating room efficiency in Norwegian hospitals indicates that many hospitals have a potential for improvement. The discrepancy between actual OR efficiency and standards used for planning of surgical facilities represents a challenge in future hospital planning.

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Operating Room Scheduling in Teaching Hospitals

Advances in Operations Research ◽

10.1155/2012/548493 ◽

2012 ◽

Vol 2012 ◽

pp. 1-16 ◽

Cited By ~ 15

Author(s):

Somayeh Ghazalbash ◽

Mohammad Mehdi Sepehri ◽

Pejman Shadpour ◽

Arezoo Atighehchian

Keyword(s):

Operating Room ◽

Real Life ◽

Operating Rooms ◽

Mixed Integer ◽

Teaching Hospitals ◽

Operating Room Scheduling ◽

Start Time ◽

The Real ◽

Mip Model ◽

Proposed Model

Operating room scheduling is an important operational problem in most hospitals. In this paper, a novel mixed integer programming (MIP) model is presented for minimizing Cmax and operating room idle times in hospitals. Using this model, we can determine the allocation of resources including operating rooms, surgeons, and assistant surgeons to surgeries, moreover the sequence of surgeries within operating rooms and the start time of them. The main features of the model will include the chronologic curriculum plan for training residents and the real-life constraints to be observed in teaching hospitals. The proposed model is evaluated against some real-life problems, by comparing the schedule obtained from the model and the one currently developed by the hospital staff. Numerical results indicate the efficiency of the proposed model compared to the real-life hospital scheduling, and the gap evaluations for the instances show that the results are generally satisfactory.

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Operating Room Management In Klaipėda University Hospital: Prospective Analysis In 2009

Sveikatos mokslai ◽

10.5200/sm-hs.2016.083 ◽

2016 ◽

Vol 26 (5) ◽

pp. 114-119

Author(s):

Renata Paškevičiūtė ◽

Geda Klimavičiūtė

Keyword(s):

Operating Room ◽

Surgical Procedures ◽

Surgical Procedure ◽

Operating Rooms ◽

Turnover Time ◽

University Hospital ◽

Time Variability ◽

Procedure Time ◽

High Turnover ◽

Scheduled Time

Summary Background: Klaipeda University Hospital performs about 30000 surgical procedures every year. The operating room (OR) is a major production unit in hospital. The OR is very expensive to construct and to operate. The goal might be thought to be full utilization of all operating rooms during all hours that they are staffed and available for scheduling. Management is the ability to apply a diverse body of knowledge to accomplish planning, organizing, staffing, leading, and controling a work group. Methods: We decided accidentally to choose and to analyze OR utilization. We had analyzed central operating department consisting of 9 ORs with regularly scheduled time 8:00 AM to 4:00 PM (8 h), full staffed in 2009 four months period (78 workdays). Four months (78 workdays) of data were collected from the 9 operating rooms surveys. Holidays and weekends were excluded.The data was analyzed using “ Statistica” version 7.Results: There were performed 1982 surgical procedures (elective – 1807 (91,2%), urgent – 99 (5%), cancelled – 76 (3,8%)) during investigated period regularly scheduled time (8 h). Actually utilized OR time of all 9 ORs was 4648 h (82,76%), it was planned to work 5616 h. Our OR utilization was 82,76% during investigated period. Total under – utilized time was 968 h (17,36%). Surgeon estimated surgical procedure time was longer than actual surgical procedure time, variability of case duration between surgical teams was high. Turnover time mean duration was 28 min. Conclusions: Our study demonstrates that our central operating department have been worked efficiently (OR utilization was 82,76%, case cancellation rate was 3,8%, mean turnover time was 28 min, prolonged turnovers were less than 10%) in 2009 (four month period).

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Overlapping Induction of Anesthesia

Anesthesiology ◽

10.1097/00000542-200508000-00023 ◽

2005 ◽

Vol 103 (2) ◽

pp. 391-400 ◽

Cited By ~ 77

Author(s):

Robert Hanss ◽

Björn Buttgereit ◽

Peter H. Tonner ◽

Berthold Bein ◽

Andreas Schleppers ◽

...

Keyword(s):

Operating Room ◽

Subgroup Analysis ◽

Economic Benefit ◽

Turnover Time ◽

Case Mix ◽

Start Time ◽

Case Mix Index ◽

Control Time ◽

Block Time ◽

Additional Costs

Background Overlapping induction (OI), i.e., induction of anesthesia with an additional team while the previous patient is still in the operating room (OR), was investigated. Methods The study period was 60 days in two followed by three ORs during surgical Block Time (7:30 am until 3:00 pm). Patients were admitted the day before surgery and were thus available and did not have surgery that day unless there was a time reduction. Facilities were already constructed. Number of cases, Nonsurgical Time (Skin Suture Finish until next Procedure Start Time), Turnover Time, and Anesthesia Control Time plus Turnover Time were studied. In addition, economic benefit was calculated. Results Three hundred thirty-five cases were studied. Using OI, the time of care of regularly scheduled cases was shortened, and the number of cases performed within OR Block Time increased (151 to 184 cases; P < 0.05). Nonsurgical Time (in h:min) decreased (1:08 +/- 0:26 to 0:57 +/- 0:18; P < 0.001), Turnover Time decreased (0:38 +/- 0:24 to 0:25 +/- 0:15; P < 0.05), and Anesthesia Control Time plus Turnover Time decreased (0:43 +/- 0:23 to 0:28 +/- 0:18; P < 0.001). Subgroup analysis showed a significant benefit of OI only in three ORs. In three ORs, economic benefit can be gained at a case mix index greater than 0.3 besides additional costs. Conclusions Overlapping induction increased productivity and profit despite the expense of additional staff. Subgroup analysis emphasizes the importance of the number of ORs involved in OI.

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Uncertainty in Knowing the Operating Rooms in Which Cases Were Performed Has Little Effect on Operating Room Allocations or Efficiency

Anesthesia & Analgesia ◽

10.1097/00000539-200212000-00048 ◽

2002 ◽

Vol 95 (6) ◽

pp. 1726-1730 ◽

Cited By ~ 19

Author(s):

Richard H. Epstein ◽

Franklin Dexter

Keyword(s):

Operating Room ◽

Operating Rooms ◽

Or Efficiency

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Ameliyathanelerde Verimliliğin Çok Ölçütlü Karar Verme Yöntemleri ile Değerlendirilmesi

Academic Perspective Procedia ◽

10.33793/acperpro.02.03.109 ◽

2019 ◽

Vol 2 (3) ◽

pp. 973-981 ◽

Cited By ~ 1

Author(s):

Şeyda Gür ◽

Tamer Eren

Keyword(s):

Operating Room ◽

Operation Time ◽

Operating Rooms ◽

Factors Affecting ◽

Hospital Managers ◽

Hospital Expenditures ◽

Cancellation Rate ◽

Network Process ◽

Effective Use ◽

Main Factor

Purpose: Determining the factors that affect productivity in operating rooms, which make up about one third of hospital expenditures, and developing strategies for these elements is a matter of importance for hospital managers. The fact that operating rooms are among the highest expenditure items and at the same time being among the highest sources of income has been the main factor in determining the factors affecting the efficiency of the operating room. Material and Method: Analytical network process method, which is one of the multi-criteria decision-making methods, which enables quantitative evaluation of qualitatively effective factors, was used. Results and Conclusion: In this study, the factors affecting the efficiency of operating rooms were evaluated. According to the results, it is seen that the usage of the operating room comes to the forefront at the same time and the personnel goes through the harmony with the colleagues. In addition, the accuracy of the operation times of the operations on the waiting list directly affects the effective use of the operating rooms. At this point, the cancellation rate of operations can be reduced by making effective plans with the correct estimated operation time. Thus, effective and efficient use of operating rooms can be increased.

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