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

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

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

2022 ◽  
Vol 16 (1) ◽  
Author(s):  
Samuel Negash ◽  
Endale Anberber ◽  
Blen Ayele ◽  
Zeweter Ashebir ◽  
Ananya Abate ◽  
...  
Keyword(s):  
Operating Room ◽  
Operating Rooms ◽  
Turnover Time ◽  
High Rate ◽  
Start Time ◽  
Or Efficiency ◽  
Tertiary Referral Center ◽  
Resource Setting ◽  
Cancellation Rate ◽  
Patient Preparation

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.

scholarly journals Organization of surgical services and operating room efficiency in Norwegian hospitals

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.

Causes and Associated factors of Operation Cancellation at Cardiothoracic Ain-Shams University Hospital

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Shaymaa M El Bokl ◽  
Aisha M Aboul-Fotouh ◽  
Ehab S Habil ◽  
Ahmed A Saleh ◽  
Azza M Hassan
Keyword(s):  
Operating Room ◽  
Health Care Providers ◽  
Clinical Status ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Care Providers ◽  
Cross Sectional ◽  
Pareto Chart ◽  
Cancellation Rate

Abstract Background Cancellation of elective operations is a sensitive indicator of operating room management. It results in loss of time, resources and affects quality of care. Operating room cancellation of elective operations is defined as cases that appeared in the definitive operative room list that ultimately were not performed on that day. Objectives To measure cancellation rate at Cardiothoracic Ain-Shams University hospital, Egypt and to identify causes and factors associated to cancellations. Methods Cross-sectional study that included 254 operations in all operating rooms of Cardiothoracic Ain Shams university hospital which provides specialized tertiary level of care. Results The overall cancellation rate is 21.7%, The most frequent cause of cancellation is standby operations accounting for 29.4%. Pareto chart shows that vital few causes are “patient prepared as stand by”, “previous long operation”, “change in Patient’s clinical status”, “equipment failure” and “ICU bed unavailable”. These causes are responsible for 80% of cancellations. Conclusion and Recommendation The avoidable causes of the problem should be addressed. Policy changes are recommended as well as continuous documentation and analysis of cancellation and its causes. Periodic awareness lectures for health care providers are suggested.

OPERATING ROOM TIME ANALYSIS IN A TERTIARY CARE HOSPITAL : TO FIND BOTTLENECKS FOR IMPROVEMENT

2021 ◽  
pp. 66-67
Author(s):  
Mede Charan Raj ◽  
Mohd. Aamir Osmani ◽  
N. Lakshmi Bhaskar
Keyword(s):  
Operating Room ◽  
Tertiary Care ◽  
Anesthesia Induction ◽  
Care Hospital ◽  
Or Efficiency ◽  
Time Motion ◽  
Motion Study ◽  
Major Operation ◽  
Room Time ◽  
Operating Room Time

BACKGROUND: rd Operating rooms (ORs) cost constitute a major investment of healthcare resources, approximating 1/3 of the total hospital budget and are among the most important areas of the hospital, contributing to both the workload and the revenue. OR efficiency is dened functionally in terms of underutilized and overutilized hours of ORtime. METHOD: A two p art study containing a prospective analysis time motion study of the operating room (OR) database to retrieve only the cases involving ve major operation theatres followed by a dichotomous open formal questionnaire with yes or no options to take the opinion of the operating room staff i.e., consultants, residents (both surgeons and anesthetists) and nurses RESULTS: Based on the time motion study the delays were mostly identied in T1-Wheel in time, T2- Anesthesia induction T6-cleaning of OR. In part 2 of the study it was evident that 65 % of the staff were of an opinion that OR is currently underutilized, 45% of the staff opined that signicant time is wasted between two surgeries and 75 % opined that they couldn't complete the scheduled list. CONCLUSIONS : Proper scheduling of regular cases and clarity in preparation of OT list, augmenting the man power, establishment good supply chain by providing sub stores in operation operating room, arrangement of sterile supplies and other equipment for the OR adequately by nursing staff could possibly lead in effective utilization of the Operating room time

A Successful Organized Effort to Improve Operating Room First-Case Starts in a Tertiary Academic Medical Center

2020 ◽  
pp. 000313482095143
Author(s):  
Melissa M. J. Chua ◽  
Keith Lewis ◽  
Yi-An Huang ◽  
Mary Fingliss ◽  
Alik Farber
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Academic Medical Center ◽  
Or Efficiency ◽  
Patient Dissatisfaction ◽  
Real Time Measurement ◽  
First Case ◽  
Academic Medical ◽  
Improve Operating Room ◽  
Operational Plan

Background Operating room (OR) inefficiency drives up cost, decreases revenue, and leads to surgeon, staff, and patient dissatisfaction. Given a low mean first-case start rate in our tertiary academic medical center, we developed a process to improve first-case start rates in an effort to increase OR efficiency. Methods A working group of the OR Executive Committee was constituted to develop and implement a multistep operational plan. This plan was predicated on a sensible staggered start framework, coordination of stakeholder responsibilities, a visual preoperative Stop/Go checklist tool, real-time measurement, and feedback. Results Within 11 days of implementation, 95% of first-start OR cases were tracked to start on time. Throughout the observation period (May 2015-July 2016), the goal of a daily mean 80% on-time start rate was either met or exceeded. Conclusions Implementation of an organized collaborative effort led to dramatic improvements in first OR case on-time rates. Such improvement in OR utilization may lead to an increase in staff and patient satisfaction and cost reduction.

scholarly journals Changes to Foot and Ankle Surgical Care During the COVID-19 Pandemic

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Alessandra L. Falk ◽  
James Hunker ◽  
Mani Kahn ◽  
Yi Guo ◽  
Chaiyaporn Kulsakdinun
Keyword(s):  
New York ◽  
Ankle Instability ◽  
Elective Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
New York State ◽  
Surgical Care ◽  
Foot And Ankle ◽  
First Case ◽  
Orthopedic Care

Category: Other; Ankle Introduction/Purpose: On March 1, 2020, the first case of novel coronavirus (COVID-19) in New York City (NYC) was confirmed. By March 16, the NYC mayor and New York State Governor issued executive orders to postpone elective surgeries. At our tertiary care academic medical care center in the Bronx, the densely populated community of 1.4 million saw many COVID-19 positive cases. In response, the hospital quickly accommodated these patients, while maintaining outpatient orthopedic care. Consequently, only emergent orthopedic cases were granted permission to rapidly proceed to surgery. Most foot and ankle cases were deemed amenable to non-surgical or delayed surgical care. The purpose of this study is to characterize a series of patients with foot and ankle pathology whose orthopedic care was altered due to the pandemic. Methods: This is a retrospective chart review from February 2020-May 2020 encompassing the time that elective surgery was on hold and one month prior, to capture those patients were scheduled for surgery prior to the pandemic. Included were patients with foot and ankle pathology that required urgent orthopedic care, who were seen in the foot and ankle clinic, fracture clinic, and subsequently in the general orthopedic clinic that was instituted on an emergent bases. Excluded were patients who required intervention to address elective foot and ankle issues such as osteoarthritis, or ankle instability, and those were referred to an outside institution for further treatment. Throughout the pandemic, contact was made with patients either directly in clinic, via a telehealth portal or telephone. Descriptive statistics are taken. Results: Of the 17 patients included in this series, 11 (65%) patients were managed non operatively. Of these, 4 chose nonoperative management due to shared decision making between the patient and surgeon. 2 patients could not have surgery due to complications related to COVID-19. As the zenith of the pandemic passed 2 patients remained fearful of infection and therefore chose non operative management. 3 patients that had been in contact with the orthopedic department refused further imaging. 6 patients were managed operatively. 2 patients had surgery during the peak of the pandemic, both of whom tested positive for COVID and who failed conservative management. 4 patients had delayed surgery. Of these four cases, 3 were malunion corrections that would have benefitted from more prompt surgery. Conclusion: There was an overall decrease in foot & ankle cases. Non- emergent foot and ankle surgery was delayed to divert resources to patients who were stricken with the COVID-19 virus. While every attempt was made to provide the appropriate care for all, a personalized approach to foot and ankle health was developed to address health concerns, preferences, and logistics. As the course of this global pandemic is still uncertain, it is imperative to have a strategy in place to deal with urgent cases, should a second wave of cases once again affect our ability to provide routine care.

scholarly journals Readmissions after elective orthopedic surgery in a comprehensive co-management care system—a retrospective analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Felix Rohrer ◽  
David Haddenbruch ◽  
Hubert Noetzli ◽  
Brigitta Gahl ◽  
Andreas Limacher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Operating Room ◽  
Spine Surgery ◽  
Orthopedic Surgery ◽  
Elective Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
Management Model ◽  
Tertiary Care Center ◽  
Related Factors

Abstract Background No surgical intervention is without risk. Readmissions and reoperations after elective orthopedic surgery are common and are also stressful for the patient. It has been shown that a comprehensive ortho-medical co-management model decreases readmission rates in older patients suffering from hip fracture; but it is still unclear if this also applies to elective orthopedic surgery. The aim of the current study was to determine the proportion of unplanned readmissions or returns to operating room (for any reason) across a broad elective orthopedic population within 90 days after elective surgery. All cases took place in a tertiary care center using co-management care and were also assessed for risk factors leading to readmission or unplanned return to operating room (UROR). Methods In this observational study, 1295 patients undergoing elective orthopedic surgery between 2015 and 2017 at a tertiary care center in Switzerland were investigated. The proportion of reoperations and readmissions within 90 days was measured, and possible risk factors for reoperation or readmission were identified using logistic regression. Results In our cohort, 3.2% (42 of 1295 patients) had an UROR or readmission. Sixteen patients were readmitted without requiring further surgery—nine of which due to medical and seven to surgical reasons. Patient-related factors associated with UROR and readmission were older age (67 vs. 60 years; p = 0.014), and American Society of Anesthesiologists physical status (ASA PS) score ≥ 3 (43% vs. 18%; p < 0.001). Surgery-related factors were: implantation of foreign material (62% vs. 33%; p < 0.001), duration of operation (76 min. vs. 60 min; p < 0.001), and spine surgery (57% vs. 17%; p < 0.001). Notably, only spine surgery was also found to be independent risk factor. Conclusion Rates of UROR during initial hospitalization and readmission were lower in the current study than described in the literature. However, several comorbidities and surgery-related risk factors were found to be associated with these events. Although no surgery is without risk, known threats should be reduced and every effort undertaken to minimize complications in high-risk populations. Further prospective controlled research is needed to investigate the potential benefits of a co-management model in elective orthopedic surgery.

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

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).

Cricoid Palpability as a Selection Criterion for Bedside Tracheostomy

2005 ◽  
Vol 133 (6) ◽  
pp. 839-844 ◽  
Author(s):  
Omar F. Husein ◽  
Douglas D. Massick
Keyword(s):  
Operating Room ◽  
Perioperative Complications ◽  
Cricoid Cartilage ◽  
Tertiary Care ◽  
Prospective Trial ◽  
Selection Criterion ◽  
University Hospital ◽  
Surgical Tracheostomy ◽  
Significant Difference ◽  
Open Surgical Tracheostomy

OBJECTIVE: To prospectively evaluate the significance of cricoid cartilage palpability as a selection criterion for bedside tracheostomy and to prospectively compare a cohort of patients undergoing bedside tracheostomy with another cohort receiving operating room tracheostomy. STUDY DESIGN/SETTING: Prospective trial comparing 2 cohorts of patients receiving tracheostomies at a tertiary care center (university hospital). In all, 220 consecutive intubated patients selected for elective tracheostomy were enrolled. Of them, 134 patients had palpable cricoid cartilage and underwent open surgical tracheostomy at the bedside. The remaining 68 patients received open surgical tracheostomies in the operating room. Demographic data, patient anatomic features, and perioperative complications were prospectively recorded. There were no statistically significant differences in age, gender, reason for admission, indication for tracheostomy, Acute Physiology and Chronic Health Evaluation II score, number of days intubated, or time required to perform the procedure for those patients whose tracheostomies were performed in the operating room versus the intensive care unit. RESULTS: Patients with a palpable cricoid cartilage had a significantly reduced perioperative complication rate compared with those without a palpable cricoid cartilage (2% vs 22%, P < 0.001). Comparison of cervical girth, mental-to-sternum distance, and thyroid-notch-to-sternum distance showed no significant difference between the 2 groups and did not further define selection criteria. CONCLUSION: This investigation prospectively confirms the safety of bedside tracheostomy placement in properly selected patients. Complication incidences are defined for open surgical tracheostomy at the bedside and in the operating room. Palpability of the cricoid cartilage has significant value as a selection criterion for bedside tracheostomy. SIGNIFICANCE: These findings will aid in the development of protocols and pathways for surgical airway management in critically ill patients to maximize cost-effective, high-quality care. EBM RATING: B-2

Statistical Method to Evaluate Management Strategies to Decrease Variability in Operating Room Utilization 

1999 ◽  
Vol 91 (1) ◽  
pp. 262-274 ◽  
Author(s):  
Franklin Dexter ◽  
Alex Macario ◽  
David A. Lubarsky ◽  
David D. Burns
Keyword(s):  
Operating Room ◽  
Structural Equation ◽  
Tertiary Care ◽  
Management Strategies ◽  
Turnover Time ◽  
Equation Model ◽  
Surgical Services ◽  
Management Interventions ◽  
The Relationship ◽  
Surgery Center

Background Operating room (OR) managers seeking to maximize labor productivity in their OR suite may attempt to reduce day-today variability in hours of OR time for which there are staff but for which there are no cases ("underutilized time"). The authors developed a method to analyze data from surgical services information systems to evaluate which management interventions can most effectively decrease variability in underutilized time. Methods The method uses seven summary statistics of daily workload in a surgical suite: daily allocated hours of OR time, estimated hours of elective cases, actual hours of elective cases, estimated hours of add-on cases, actual hours of add-on cases, hours of turnover time, and hours of underutilized time. Simultaneous linear statistical equations (a structural equation model) specify the relationship among these variables. Estimated coefficients are used in Monte Carlo simulations. Results The authors applied the analysis they developed to two OR suites: a tertiary care hospital's suite and an ambulatory surgery center. At both suites, the most effective strategy to decrease variability in underutilized OR time was to choose optimally the day on which to do each elective case so as to best fill the allocated hours. Eliminating all (1) errors in predicting how long elective or add-on cases would last, (2) variability in turnover or delays between cases, or (3) day-to-day variation in hours of add-on cases would have a small effect. Conclusions This method can be used for decision support to determine how to decrease variability in underutilized OR time.

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