Because most anesthesiologists work in the operating room setting, anesthesiologists are involved with the management of the operating room suite (or “theater”). Even if they are not responsible for the management, anesthesiologists still want to understand the decision-making process and metrics that affect their daily schedule and duties. In the United States, anesthesiologists can attend in-person conferences and seminars on leadership, practice management, and operating room management offered by national associations, online webinars and resources, and textbooks. Although these offerings will give anesthesiologists groundwork for calculations of metrics, e.g., productivity and efficiency, an in-depth discussion is not done.In contrast, Practical Operating Theater Management: Measuring and Improving Performance and Patient Experience provides the reader in-depth materials on data-driven metrics, including operating room efficiency, productivity, utilization, and scheduling. The book purposely is designed not to cover leadership or management styles but focuses on collecting and employing operating room data in a manner that is practical and applicable.The book has two functional sections. The first includes an introduction and eight chapters that cover the terms and principal content, as well as efficiency, productivity, scheduling, planning, staffing and contracts, operating room finances, and preoperative patient preparation. The second section contains five chapters examining operating room management in different countries, including Japan, The Netherlands, Switzerland, Australia, and the United States. Chapter 14 then covers operating room safety, and chapter 15 (the last) provides an overview of the book by a contributor.Some of the topics discussed include the different formats used to manage surgical block times, as well the importance of normalizing terms and definitions so the collected data can be reported, analyzed, and acted upon effectively. Among the data that proves useful to collect is operating room capacity, demand by surgeons, utilization rate, overruns, cancellation rate, start times, and turnover times, with some of these bundled into key performance indicators. Of these, efficiency (as defined in chapter 2), on-time start, and turnover times are considered fundamental.Chapter 2 is central to the book, and in it the author cautions that the much-used and maligned measurement of on-time starts or cancellation rates by themselves are a poor measure of overall operating room efficiency. Efficiency as a measurement is clearly defined in a mathematical formula, and the manner in which operating room management decisions affect it is discussed in detail. Subsequent chapters cover measures of productivity (chapter 3) and strategies for scheduling (chapter 4), with an emphasis on maintaining and utilizing a real-time database of facility-specific surgical times, capacity planning of schedules, and add-on operating room capacity (chapter 5). Operating room staff contracts and the prominent role of staffing in providing the capacity is covered in chapter 6. Chapters 7 and 8 cover operating room finances and preoperative patient preparation, respectively.Although the book’s editor and major contributors are from the United Kingdom, the concepts are applicable to operating room management in the United States as well as other countries. In fact, the latter half of the book explores the similarities and differences in operating room management in different countries, including New Zealand, Japan, The Netherlands, Switzerland, and the United States. It is amazing that anesthesiologists from many different countries face similar challenges.For data-driven metrics, it is not surprising that the book relies on a mathematical approach to data. This math-heavy approach would be more appealing to business-trained operating room managers rather than physicians, although the author did attempt to make it more accessible by incorporating these formulas into Excel spreadsheets. We believe anyone interested in implementing data-driven decision-making processes will be able to follow the mathematical progression that occurs in the first half of the book.Overall, this book is a useful resource to anesthesiologists, operating room managers, and financial analysts on the topics of data-driven metrics. It provides a unique educational resource for those who are new to the topic of operating room efficiency, utilization, and productivity. For those who have been working with these concepts, the book provides a resource to reexamine our formulas with an international perspective.
MP68-19 USE OF THE OR BLACK BOX® TO EVALUATE OPERATING ROOM ECONOMIC EFFICIENCY
MP68-19 USE OF THE OR BLACK BOX® TO EVALUATE OPERATING ROOM ECONOMIC EFFICIENCY
21Enhancement opportunities in operating room utilization; with a statistical appendix
Enhancement opportunities in operating room utilization; with a statistical appendix
88Operating room utilization alone is not an accurate metric for the allocation of operating room block time to individual surgeons with low caseloads.
Many surgical suites allocate operating room (OR) block time to individual surgeons. If block time is allocated to services/groups and yet the same surgeon invariably operates on the same weekday, for all practical purposes block time is being allocated to individual surgeons. Organizational conflict occurs when a surgeon with a relatively low OR utilization has his or her allocated block time reduced. The authors studied potential limitations affecting whether a facility can accurately estimate the average block time utilizations of individual surgeons performing low volumes of cases. Discrete-event computer simulation. Neither 3 months nor 1 yr of historical data were enough to be able to identify surgeons who had persistently low average OR utilizations. For example, with 3 months of data, the widths of the 95% CIs for average OR utilization exceeded 10% for surgeons who had average raw utilizations of 83% or less. If during a 3-month period a surgeon's measured adjusted utilization is 65%, there is a 95% chance that the surgeon's average adjusted utilization is as low as 38% or as high as 83%. If two surgeons have measured adjusted utilizations of 65% and 80%, respectively, there is a 16% chance that they have the same average adjusted utilization. Average OR utilization can be estimated more precisely for surgeons performing more cases each week. Average OR utilization probably cannot be estimated precisely for low-volume surgeons based on 3 months or 1 yr of historical OR utilization data. The authors recommend that at surgical suites trying to allocate OR time to individual low-volume surgeons, OR allocations be based on criteria other than only OR utilization (e.g., based on OR efficiency).
Read moreHUBUNGAN KETEPATAN ESTIMASI DURASI OPERASI DENGAN UTILISASI KAMAR OPERASI ELEKTIF DI INSTALASI BEDAH SENTRAL RSUD Dr. SAIFUL ANWARMALANG
The operating room is a vital service in hospitals. The quality of service from theoperating room can be assessed from one indicator, namely operating room utilization.Utilization is the actual time required to carry out additional operations turnover (operationtransfer time) divided by the available time, where turnover averages over 15 minutes.Estimation of the duration of surgery is an important factor in operating room utilization.The aim of this study was to determine the relationship between the accuracy of estimatingthe duration of surgery and the utilization of elective operating rooms in the Central SurgeryInstallation at RSUD Dr. Saiful Anwar Malang. This research method is a prospective cohortfor 19 working days. The sampling technique uses total sampling. The results of the studywere that almost all 284 operations (93.4%) were accurate in estimating the duration of theoperation according to estimates, and the majority of 197 operating rooms (64.8%) hadoperating room utilization in the poor category. Data analysis uses Chi-Square which showsthat the p-value is 0.007 <0.05, which means there is a relationship between the estimatedduration of surgery and operating room utilization. Operating room utilization can beoptimal if one of the factors can be met, namely the operation can be completed on time (onTime) which means the estimation of the duration of the operation must also be correct.Therefore, there is a need for synergy between multidisciplines in the operating room andmanagement in setting schedules and standards for estimating the duration of operations andit is necessary to re-socialize the quality of the operating room for users of the operatingroom and the rooms involved in it, because part of the quality of the operating room is afactors that can influence operating room utilization.
Read moreThe Benefits of Electronic Health Record (EHR) on Operating Room Efficiency: Literature Review
Background:The Electronic Health Record (EHR) system is a systematic collection of health information based on electronics and integrated with information systems in the hospital network. The use of the EHR system is very important in a comprehensive strategy to improve the quality of health and patient safety, especially in the operating room. Purpose: to find out the benefits of using EHR on operating room efficiency which includes treatment costs, OR efficiency metrics, turn over time, documentation time and nursing quality. Method: This literature review was searched through relevant evidence-based studies usingdatabase at PROQUEST, Science Direct, Scopus, Elsevier from 2017-2021. Results:The EHR system has a cost-saving impact on the average operating room cost of 36-37 dollars per minute and can reduce costs during pre, intra and post surgery. For the FPIR value from the data of 27,403 cases after post-implementation to 9,630 cases, it means that there are no missing patients to enter the operating room, while at the time of delay the FCOTSin pre-implementation of EHR was 1972 cases or (7.20%) and post-implementation 377 cases (3.91%). Meanwhile, the turn over time (TOT) after post implementation showed a significant increase of 53 minutes, p < 0.001. The introduction of the EHR also had an impact on increasing documentation time for nurses from 23% to 35%. In addition, it also provides benefits to the quantity and quality of nursing. Conclusion: The usefulness of the EHR system contributes to increasing the efficiency of the operating room so that it can provide effectiveness in service and quality of care. Nurses are expected to be able to input the EHR system and service agencies can implement these technological developments
Read moreOperating Room Leadership and Perioperative Practice Management, 2nd ed
Operating Room Leadership and Perioperative Practice Management is a revised second-edition textbook, intended to be an up-to-date resource for all aspects of operating room management. This edition has 11 new chapters and there has been a substantial revision to the 27 chapters that were retained from the first edition. The book is organized into 5 sections: (1) leadership and strategy; (2) economic considerations, efficiency, and design; (3) surgical and anesthesia practice management; (4) nursing; and (5) safety, standards, and information technology. The contributors to the book are experts in their fields and the majority of the 71 authors are department chairs, medical center chief executive officers, executive directors, or directors of coding or compliance. One of the strengths of this book is the clarity of writing. Each chapter is approximately 10–15 pages in length. The chapters deconstruct complex topics, provide clear definitions for commonly used terms, and, most importantly, provide concrete anesthesia-specific examples. Figures and tables supplement almost every chapter and highlight key learning points. The section on leadership and strategy is perhaps one of the best-written sections of the book, as many of the principles commonly used in the business world are not familiar to many practicing anesthesiologists, yet the reader is given a sufficient primer to have a functional understanding of the relevant tenets. The chapter on The Joint Commission, Center for Medicare and Medicaid Services, and other standards, in particular, is an excellent summary of the history of the modern health care system and the evolution of standards and accreditation over the past century. As the legislative landscape has changed significantly in a relatively short period of time, the authors provide a concise summary of key concepts affecting all anesthesiologists. Another strength of the book is the comprehensive discussion of all aspects of operating room management, from conception of operating room design to staffing and personnel relationships. The authors recognize that the operating room environment is complicated, with its own culture. Successful leaders must understand this complex environment and work collaboratively to effectively manage the operating room. While this overview works well for most chapters, some of the chapters do seem slightly superficial, in particular Chapters 5 (Implications of Emotional Intelligence and Collaboration for Operating Room Leadership and Management), 16 (Efficiency and Scheduling), and 27 (Operating Room Metrics). These chapters have a cursory discussion of 3 very complex topics, leave the reader wanting more information, and do not give the reader the necessary tools to act on the information presented. This might limit the usefulness of the book for someone without existing leadership experience. A further limitation is that the book is intended for use by a multidisciplinary audience, thus some of the information presented, particularly in the preoperative evaluation and management chapter, may seem basic to the established anesthesiologist. Finally, the title of Section 4, “Nursing,” is a bit misleading. While all 3 chapters in this section have nursing implications, the section delves into broader topics, such as staffing and throughput, which are relevant to a broader audience. Ultimately, successful operating room management involves not only administrative efficiency but also knowledge of the legislative landscape and development of high-performing teams who deliver patient care. This book is an excellent primer for physician anesthesiologists who would like to ascend to perioperative leadership roles. While the contents of this book are likely to be a review for experts or established leaders, it is useful for resident trainees, those stepping into leadership positions, or even anesthesiologists who are not in leadership but who would like to better understand the mechanics of operating room management. Nicole Higgins, MDDepartment of AnesthesiologyNorthwestern University Feinberg School of MedicineChicago, IllinoisPaloma Toledo, MD, MPHDepartment of AnesthesiologyNorthwestern University Feinberg School of MedicineChicago, IllinoisCenter for Healthcare StudiesNorthwestern University Feinberg School of MedicineChicago, Illinois[email protected]
Read more3Analysis of Operating Room Activities in the Dermatology Department at Hospital Universitario de Fuenlabrada (2005-2010)
Analysis of Operating Room Activities in the Dermatology Department at Hospital Universitario de Fuenlabrada (2005-2010)
Implications of Emotional Intelligence and Collaboration for Operating Room Leadership and Management
Effective leadership is critical to ensuring safety, efficiency and maximum productivity in the operating room (OR). This practical, evidence-based book unpicks the dynamics of a successful OR environment to underline the key techniques for management of policies, systems, staff members and teams. Fully updated to include recent clinical guidelines, the book provides the 'A-Z' of OR management, including sections on metrics, scheduling, human resource management, leadership principles, economics, quality assurance, recovery and ambulatory practice. New chapters include future healthcare models, emergency preparedness and budgets amongst other topics. Written by authors with unrivalled experience in the field, chapters are laid out in an easy and clinically helpful format to assist learning, and real-life case studies cover 73 different clinically relevant pain topics. This book is an essential guide for anyone working in the OR including anaesthesiologists, surgeons, nurses, and administrators.
Read moreMP16-02 INFLUENCE OF INTERDEPARTMENTAL COLLABORATION ON UTILIZATION OF NEOADJUVANT CHEMOTHERAPY PRIOR TO CYSTECTOMY; A 14-YEAR EXPERIENCE
MP16-02 INFLUENCE OF INTERDEPARTMENTAL COLLABORATION ON UTILIZATION OF NEOADJUVANT CHEMOTHERAPY PRIOR TO CYSTECTOMY; A 14-YEAR EXPERIENCE
Read more6Operating Room Efficiency measurement made simple by a single metric.
Operating room (OR) efficiency is a hot topic in OR management studies. Benefits of OR efficiency maximization include financial savings, improved patient safety, greater satisfaction for patients and health workers, and increased productivity. However, how to measure the efficiency of an OR suite still remains a pending question. Many performance indicators have been developed (1) and one of the most frequent approaches consists of choosing a set of indicators to create a dashboard for the monitoring of surgical activities. Macario proposed a scoring system based on eight performance indicators (2). A similar approach was used in The Canadian Paediatric Surgical Wait Times Project (3). Although the use of dashboards and scoring systems allows for a wide and in-depth understanding of the numerous factors that contribute to efficiency, it may also raise problems. The use of multiple indicators involves gathering large amounts of data that are not routinely available in every context and are subject to different interpretations if metrics show divergent trends. Moreover, it is not possible to properly establish relative weights among metrics. We propose a different approach, based on a single and overall indicator that can be used as a proxy for OR efficiency. We considered four elements as a minimum set for composing our indicator: raw utilization (RU), turn-over time (TT), preparation time (PT) and case cancellation (CC) (4). RU formed the basis for our considerations, as it is one of the most common and widespread performance indicators. RU represents the percent of time that patients spend in OR during resource hours.
Read more14How Does TeamSTEPPS Affect Operating Room Efficiency?
How Does TeamSTEPPS Affect Operating Room Efficiency?
15Resuming elective surgery after COVID-19: A simulation modelling framework for guiding the phased opening of operating rooms
Resuming elective surgery after COVID-19: A simulation modelling framework for guiding the phased opening of operating rooms
Read moreLearnings From an Audit of Anesthesia Information Management System for Neurosurgery Operating Room Utilization.
An anesthesia information management system (AIMS) can be used to assess operating room utilization. The aim of this study was to assess neurosurgery OR utilization patterns using an AIMS. This retrospective audit was performed at a tertiary neurosciences university hospital over a 1-year period. The time taken for various OR activities were identified from the timestamps recorded in the AIMS and used to assess whether the type of surgical procedure, patient's American Society of Anesthesiologists (ASA) physical status score, case schedule order, or surgeons' experience impacted operating room utilization. Data from 1800 patients were available for analysis. Utilization times for various operating room activities were different based on the type of surgery, ASA grade, case order, and surgeon seniority. The main differences were found in the durations of surgery and anesthesia, and the time from the arrival of a patient into the operating room and the start of surgery, which were significantly impacted by the type of surgery, case order, and surgeon seniority ( P <0.001), but not by ASA score. AIMS can effectively track and identify operating room utilization patterns by analyzing the durations of various operating room activities. Prospective multicenter studies are required to validate these findings in different surgical populations and centers.
Read more203Increasing Operating Room Efficiency Through Parallel Processing
Because of rising costs and shrinking reimbursements, hospitals must continually find ways to improve efficiency and productivity. This study attempts to increase caseloads in ambulatory surgery operating rooms while maintaining patient satisfaction and safety. In most hospitals, patients move through their operative day in a linear fashion, starting at registration and finishing in the recovery room. Given this pattern, only 1 patient may occupy the efforts of the operating room team at a time. By processing patients in a parallel fashion, operating room efficiency and patient throughput are increased while costs remain stable. Patients undergoing hernia repairs under local anesthesia with intravenous sedation were divided into a control group and an experimental group. Patients in the control group received their local anesthesia in the operating room at the start of the surgery. The experimental group patients received their local anesthesia in the induction room by the surgeon while the operating room was being cleaned and set up. While operative time for the control group and the experimental group were nearly identical, the turnover time and the induction time were significantly shorter for the experimental group. The cumulative reduction in time during the operative day was sufficient to allow the addition of new operative cases. This study demonstrates a system of increasing operating room efficiency by changing patient flow rather than simply working to streamline existing steps. This increase in efficiency is not associated with the expansion of hospital budgets or a decrease in patient safety or satisfaction.
Read more18Impact of the reduction of anaesthesia turnover time on operating room efficiency
Background and objective: We investigated whether an increase in anaesthesia staffing to permit induction of anaesthesia before the previous case had ended ('overlapping') would increase overall efficiency in the operating room. Hitherto, the average duration of operating sessions was too long, thus impeding the timely commencement of physicians' ward duties. Methods: The investigation was designed as a prospective, non-randomized, interrupted time-series analysis divided into three phases: (a) a baseline of 3.5 months, (b) a 2.5 month intervention phase, in which anaesthesia staffing was increased by one attending physician and one nurse, and (c) a further 2 months under baseline conditions. Data focussed on process management were collected from operating room staff, anaesthesia personnel and surgeons using a structured questionnaire collected daily during the entire study. Results: Turnover time between consecutive operations decreased from 65 to 52 min per operation (95% CI: 9; 17; P = 0.0001). Operating room occupancy increased from 4:28 to 5:27 h day−1 (95% CI: 50; 68; P = 0.005). The surgeons began their work on the ward 35 min (95% CI: 30; 40) later than before the intervention and their overtime increased from 22:36 to 139:50 h. Conclusions: The time between surgical operations decreased significantly. Increased operating room efficiency owing to overlapping induction of anaesthesia allows more intense scheduling of operations. Thus, physicians and nurses can be released to spend more time with their patients in the ward. Improving the efficiency of the operating room alone is insufficient to improve human resource management at all levels of a surgical clinic.
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