Efficiency of the Operating Room

fThe American Journal of Surgery 185 (2003) 244 –250

Core competencies

Efficiency of the operating room suite
Avi A. Weinbroum, M.D.a,b,d,*, Perla Ekstein, M.D.b,d, Tiberiu Ezri, M.D.c,d b Post-Anesthesia Care Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv 64239, Israel Departments of Anesthesia and Critical Care Medicine, Tel-Aviv Sourasky Medical Center, Til-Aviv, Israel c Department of Anesthesia, Wolfson Hospital, Holon, Israel d Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Manuscript received January 28, 2002; revised manuscript September 6, 2002

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Abstract Background: The need to control high costs of running operating rooms while providing for timely patient care led us to assess the time wasted in the operating room (OR). Methods: OR use by two general surgery and two orthopedic departments in a metropolitan public hospital were analyzed, and the time elapsed when a scheduled OR remained unused or the patient was still awaiting surgery was measured. Results: OR “time-waste” defined as the time in which the scheduled OR was not busy with the scheduled patient amounted to 79 hours over the 30-day study period (15% of total time). It was wasted owing to inappropriately prepared patients (12%), unavailability of surgeons (7%), insufficient nursing staff, anesthesiologists, or OR assignment to emergency surgery (59%), congestion of the postanesthesia care unit (10%), and delay in transport to the OR (2%) Another issue delineated was the frequent occurrence of surgical cases running longer than their scheduled time (termed “spill-over”), outrunning the staffing expectations after 3:00 PM and delaying admission of add-on and emergency procedures, adding 33% to the time wasted. A quality-assurance committee review resulted in implementation of new guidelines, and within 3 months several underlying causes were rectified, and time-waste and spill over time was reduced by 35%. Surgical time predictions were also

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