10 Steps to Improve Efficiency in the Operating Room

Many (of not most) surgeons complain about operating room (OR) efficiency. Hospitals can benefit from improving OR efficiency, because most ORs top their list of the most costly divisions. A recent issue of the Journal of the American College of Surgeons described successful low-cost, low-technology measures implemented at a tertiary-care academic medical center/Level I trauma center in Louisville, KY.

This research team, members of the Department of Surgery, University of Louisville School of Medicine, implemented interventions designed to improve preadmission testing and OR scheduling in March 2012. They tracked statistics from the 36-month period before implementation and the ensuing months.

This study provides the benefit of a large data base. During the 10 month before the program started, 6,581 cases were scheduled for the OR. In the following 26 months, 17,574 cases were scheduled.

The improvement team identified system constraints and created low-technology, practical solutions. These included the following:

• Establishing a hospital-wide perioperative management team consisting of anesthesia and surgical services department chairs, administrators, perioperative nursing managers; quality and patient safety representatives, and interested senior level surgeons and anesthesiologists. They describe this as a “bottom-up” approach that involves engaging staff who work in the OR, and having others who don’t work there engage in ground-level discussions.
• Assigning a Certified Registered Nurse Anesthetist (CRNA) to manage the OR schedule and enforce quality initiatives
• Distributing performance metrics to all stakeholders to foster an efficient, accountable culture.

The researchers describe improvement in first-case on-time (FCOT) starts as “dramatic.” At the study’s start, 39.3% of cases were considered FCOT starts. At the end of one year, 83.8% of cases started on time. Starting on time allowed the team to schedule more cases and use block time better.

OR utilization increased steadily, as did case volume. The 12-month rolling average of cases per month grew from around 600 to approximately 650. Significant increases in case volume occurred during peak OR time (7 am to 5 pm), not after hours.

These researchers report that their OR problems had existed for years and seemed insurmountable, although this center has and has had a very low turnover time. Their simple changes cascaded and improved OR efficiency and case volume.