Reorganizing patient care and workflow in the operating room: a cost-effectiveness study

Area of Science:

• Surgical Operations Management
• Healthcare Systems Engineering
• Perioperative Care

Background:

• Long operating room (OR) turnover times are perceived by surgeons as a significant barrier to productivity.
• A hypothesis was formulated: redesigning the OR and perioperative staffing using parallel processing could enhance throughput and reduce healthcare costs.

Purpose of the Study:

• To evaluate the impact of a redesigned OR and perioperative staffing system on patient throughput and cost-effectiveness.
• To test the hypothesis that parallel processing in an OR setting improves efficiency.

Main Methods:

• A state-of-the-art OR suite, the OR of the Future (ORF), was utilized as a living laboratory.
• Phase I involved a prospective trial assessing reduced patient flow-time, wait-time, and operative procedure time.
• Phase II used a retrospective study to analyze influencing factors, with cost-effectiveness evaluated via modified process costing.

Main Results:

• The ORF demonstrated significantly shorter median Wait Time (12.5 min vs 23.8 min), Operative Procedure Time (56.1 min vs 70.5 min), Emergence Time (10.9 min vs 14.5 min), and Total Patient OR Flowtime (79.5 min vs 108.9 min) compared to standard ORs (SORs).
• The ORF achieved a potential increase of 2 patients per day, primarily due to reduced non-operative time (turnover time).
• Median cost per patient was comparable ($3,165 ORF vs $2,645 SOR), with an incremental cost-effectiveness ratio of $260 for the ORF.

Conclusions:

• The redesigned perioperative system enhances patient flow and daily treatment capacity.
• Cost-effectiveness is supported, as increased productivity is expected to offset higher staffing costs in the ORF model.
• The benefits of the ORF system are most pronounced for multiple, short-to-medium duration procedures (under 120 minutes).