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Criteria for assessing operating room utilization in a free-standing children's hospital
Lynne R Ferrari1, Anne Micheli, Christopher Whiteley
1Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, 300 Longwood Avenue,Boston, MA 02115, USA. lynne.ferrari@childrens.harvard.edu
Insights
This study found that optimizing surgical workflow and scheduling in a pediatric hospital increased operating room (OR) utilization to 79%. Further improvements could potentially reach 85-90% utilization.
Area of Science:
- Healthcare Management
- Surgical Operations
- Pediatric Healthcare
Background:
- Operating room (OR) hours are a critical resource in surgical facilities.
- Factors influencing OR utilization include scheduling, efficiency, and institutional culture.
- No prior measure existed for OR hour utilization in academic pediatric institutions.
Purpose of the Study:
- To define the utilization of surgical suite staffed block time at Children's Hospital Boston (CHB).
- To determine if workflow changes could increase measured OR utilization.
- To establish a benchmark for pediatric OR efficiency.
Main Methods:
- Operating room efficiency was measured using utilization and turnover ratios (observed/expected) in fiscal year 2009.
- Analysis included 27,851 cases, with elective cases scheduled electronically and urgent cases filling vacant slots.
- Time series analysis evaluated expected vs. observed utilization and turnover changes.
Main Results:
- Average OR utilization was 79%, with monthly ratios ranging from 73% to 87%.
- Improvements in on-time first-case starts potentially increased staffed block time utilization.
- Turnover time significantly decreased over the period, indicating improved OR efficiency.
Conclusions:
- CHB achieved a mean utilization of 79% for scheduled block time by optimizing workflow across surgical, anesthesia, and nursing teams.
- Strategies included shortening turnover times, accommodating emergency procedures, and extending staffing for complex cases.
- Simulated models suggest optimal pediatric OR utilization may range from 85% to 90%.
Background:
The staffed hours of operation in any surgical facility are a valuable institutional resource. The realistic target for the utilization of this resource is dependent on many factors including scheduling, efficiency, and culture of the facility. There is no previously reported measure for the actual utilization of staffed regular operating room (OR) hours in an academic pediatric institution. The leadership of the perioperative services at Children's Hospital Boston (CHB) sought to define the utilization of surgical suite staffed block time hours at that institution and in addition determine whether changes in workflow could increase the measured utilization.
Methods:
Operating room efficiency in fiscal year 2009 was measured using two variables: utilization and turnover measured in hours for each month in fiscal year 2009, recorded in hours expressed as ratios (observed/expected) and as differences (observed - expected). A total of 27,851 cases from October 1, 2008, through September 30, 2009, were analyzed. All elective cases were scheduled electronically following institutional guidelines; urgent or emergent procedures were scheduled into vacant time slots on the day of the procedure. Time series analysis based on a generalized autoregressive moving average process was used to compare expected with observed utilization and to evaluate changes in utilization and turnover ratios.
Results:
Efficiency as measured by capped utilization divided by total available time in the OR averaged 79%. Utilization ratios ranged from a low of 73% in February 2009 to a high of 87% in July 2009. An improvement in on-time first-case starts may have contributed to the increase in the utilization of staffed block time. Turnover time as defined by turnover ratio decreased significantly over time, indicating an improved efficiency in the OR starting in April 2009.
Conclusions:
Adhering to the specific guidelines that are followed at CHB, the mean utilization of scheduled block time was 79%. This was achieved by maximizing workflow in the surgical, anesthesia, and nursing disciplines to shorten turnover time, fill gaps in the elective schedule with emergency procedures, and provide staffing to accommodate cases that extend beyond the scheduled staffed time prior to the reporting period. Simulated models from other pediatric institutions suggest that the optimal utilization of designated time periods in a surgical facility may range from 85% to 90%.
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