Efficiency of the operating room suite

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 improved. Shortage of nurses and anesthesiologists, and OR emergency reassignment remained the major causes of OR waste time. Conclusions: Continuous surveillance on OR suite-patients' prompt care, repeated evaluation, and wise staff deployment- could maximize OR efficiency. (C) 2003 Excerpta Medica Inc. All rights reserved.