Deliberate Perioperative Systems Design Improves Operating Room Throughput
| Autor: | Julian M. Goldman, Bethany Daily, David W. Rattner, James E. Stahl, Marie T. Egan, Richard A. Wiklund, Warren S. Sandberg |
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| Rok vydání: | 2005 |
| Předmět: |
Operating Rooms
Time Factors Offset (computer science) business.industry Perioperative Confidence interval Appointments and Schedules Nursing care Anesthesiology and Pain Medicine Workflow Case mix index Facility Design and Construction Anesthesia Humans Revenue Medicine Operations management Performance improvement business |
| Zdroj: | Anesthesiology. 103:406-418 |
| ISSN: | 0003-3022 |
| DOI: | 10.1097/00000542-200508000-00025 |
| Popis: | Background: New operating room (OR) design focuses more on the surgical environment than on the process of care. The authors sought to improve OR throughput and reduce time per case by goal-directed design of a demonstration OR and the perioperative processes occurring within and around it. Methods: The authors constructed a three-room suite including an OR, an induction room, and an early recovery area. Traditionally sequential activities were run in parallel, and nonsurgical activities were moved from the OR to the supporting spaces. The new workflow was supported by additional anesthesia and nursing personnel. The authors used a retrospective, case- and surgeon-matched design to compare the throughput, cost, and revenue performance of the new OR to traditional ORs. Results: For surgeons performing the same case mix in both environments, the new OR processed more cases per day than traditional ORs and used less time per case. Throughput improvement came from superior nonoperative performance. Nonoperative Time was reduced from 67 min (95% confidence interval, 64‐70 min) to 38 min (95% confidence interval, 35‐40 min) in the new OR. All components of Nonoperative Time were meaningfully reduced. Operative Time decreased by approximately 5%. Hospital and anesthesia costs per case increased, but the increased throughput offset costs and the global net margin was unchanged. Conclusions: Deliberate OR and perioperative process redesign improved throughput. Performance improvement derived from relocating and reorganizing nonoperative activities. Better OR throughput entailed additional costs but allowed additional patients to be accommodated in the OR while generating revenue that balanced these additional costs. OPERATING room (OR) time is expensive, with an estimated cost of $10 –30/min. 1,2 Concomitantly, minimally invasive surgery is increasingly prevalent, with longer setup times for the technology required to support minimally invasive procedures in multipurpose ORs. At the same time, changes in reimbursements and increasing costs create tremendous pressure to maximize surgical productivity from valuable OR space. Considerable recent effort has been applied to optimizing the use of OR time to improve access for patients, reduce costs, and improve patient and personnel satisfaction. However, emphasis on reduction of turnover time has not been rewarding. The achievable reduction in time between operations is likely to be too small to accomplish additional cases during regular OR hours. 3 Alternatively, the reductions in total case time that must be achieved to reliably accommodate an additional case within scheduled hours vary as a function of the total case time but are probably too large to be obtained by incremental improvements in standard perioperative processes. 4 Against this backdrop, we decided to change the basic paradigms by which one of our ORs functions, seeking to achieve increased throughput. |
| Databáze: | OpenAIRE |
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