Efficiency and Safety in Operating Rooms: Current Limitations and Future Directions
Keywords:
Operating Rooms, Operating Room Economics, Operating Room Ergonomics, Patient SafetyAbstract
Studies on clinical adverse events in hospitals have identified the Operating Room (OR) as the most probable place for medical error. Therefore, it is highly important to improve efficiency and safety within the OR. We decided to review the current available evidence in the literature on the topic of OR efficiency and safety; we identified the limitations and pitfalls within the OR, searched for the roots for their existence and described future directions and recommendations. In addition, we explored the economic cost implications as they pertain to the OR use under those limitations, all of which synthetically, bring forward the necessity that things need to change within the OR otherwise a healthcare unit’s finances will continue to take significant losses. Finally, we briefly describe a future solution for the OR.
References
Arora S, Hull L, Sevdalis N, et al. Factors compromising safety in surgery: stressful events in the operating room. Am J Surg. 2010;199(1):60-65.
2. Barbagallo S, Corradi L, de Ville de Goyet J, et al. Optimization and planning of operating theatre activities: an original definition of pathways and process modeling. BMC Med Inform Decis Mak. 2015;15(1):38.
3. Cardoen B, Demeulemeester E, Beliën J. Operating room planning and scheduling: A literature review. Eur J Oper Res. 2009;201:921-932.
4. Girotto JA, Koltz PF, Drugas G. Optimizing your operating room: Or, why large, traditional hospitals don’t work. Int J Surg. 2010;8(5):359-367.
5. Li D, Wang S, Powers C. A systematic strategy for perioperative process improvement. In: IIE Annual Conference and Expo 2013. ; 2013:626-634.
6. Meredith JO, Grove AL, Walley P, Young F, Macintyre MB. Are we operating effectively? A lean analysis of operating theatre changeovers. Oper Manag Res. 2011;4(3-4):89-98.
7. Weinbroum AA, D M, Ekstein P, D M, Ezri T, D M. Efficiency of the operating room suite. 2003;185:244-250.
8. Sandberg WS, Daily BA, Egan M, et al. Deliberate Perioperative Systems Design Improves Operating Room Throughput. Anesthesiology. 2005;103:406-418.
9. Kurmann A, Tschan F, Semmer NK, Seelandt J, Candinas D, Beldi G. Human factors in the operating room - The surgeon’s view. Trends Anaesth Crit Care. 2012;2(5):224-227.
10. Matern U, Koneczny S. Safety, hazards and ergonomics in the operating room. Surg Endosc. 2007;21(11):1965-1969.
11. Berguer R. Surgery and ergonomics. Arch Surg. 1999;134(9):1011-1016.
12. King PH, Fries RC, Johnson AT. Design of Biomedical Devices and Systems. CRC Press, Taylor & Francis Group,; 2015.
13. Burlington DB. Human factors and the FDA’s goals: Improved medical device design. Biomed Instrum Technol. 1996;30(2):107-109.
14. Lakbala P, Sobhani G, Lakbala M, Inaloo KD, Mahmoodi H. Sharps injuries in the operating room. Environ Health Prev Med. 2014;19(5):348-353.
15. Bharathan R, Aggarwal R, Darzi A. Operating room of the future. Best Pract Res Clin Obstet Gynaecol. 2013;27(3):311-322.
16. Klein M, Andersen LPH, Alamili M, Gögenur I, Rosenberg J. Psychological and Physical Stress in Surgeons Operating in a Standard or Modern Operating Room. Surg Laparosc Endosc Percutan Tech. 2010;20(4):237-242.
17. Kenyon TAG, Urbach DR, Speer JB, et al. Dedicated minimally invasive surgery suites increase operating room efficiency. Surg Endosc. 2001;15(10):1140-1143.
18. Garbey M, Joerger G, Huang A, et al. An intelligent hospital operating room to improve patient health care. J Comput Surg. 2015;2(1):3.
19. Nundy S, Mukherjee A, Sexton JB, et al. Impact of Preoperative Briefings on Operating Room Delays. Arch Surg. 2008;143(11):1068.
20. Porta CR, Foster A, Causey MW, et al. Operating room efficiency improvement after implementation of a postoperative team assessment. J Surg Res. 2013;180(1):15-20.
21. Tadeo JR. Improving Operating Room Efficiency: A Quality Improvement Project. 130, 910-917 (2014).
22. Doll D, Wieferich K, Erhart T, Hoenemann C. Waiting for Godot. Eur J Anaesthesiol. 2014;31(7):388-389.
23. Dexter F, Epstein RH, Marcon E, Ledolter J. Estimating the incidence of prolonged turnover times and delays by time of day. Anesthesiology. 2005;102(6):1242-8;
24. STAHL J, SANDBERG W, DAILY B, et al. Reorganizing patient care and workflow in the operating room: a cost-effectiveness study. Surgery. 2006;139(6):717-728.
25. Hanss R, Buttgereit B, Tonner PH, et al. Overlapping induction of anesthesia: an analysis of benefits and costs. Anesthesiology. 2005;103(2):391-400.
26. Torkki PM, Marjamaa RA, Torkki MI, Kallio PE, Kirvelä OA. Use of anesthesia induction rooms can increase the number of urgent orthopedic cases completed within 7 hours. Anesthesiology. 2005;103(2):401-405.
27. Doll D, Kauf P, Wieferich K, Schiffer R, Luedi MM. Implications of Perioperative Team Setups for Operating Room Management Decisions. Anesth Analg. 2017;124(1):262-269.
28. Stepaniak PS, Vrijland WW, de Quelerij M, de Vries G, Heij C. Working With a Fixed Operating Room Team on Consecutive Similar Cases and the Effect on Case Duration and Turnover Time. Arch Surg. 2010;145(12):1165.
29. Stepaniak PS, Heij C, Buise MP, Mannaerts GHH, Smulders JF, Nienhuijs SW. Bariatric Surgery with Operating Room Teams that Stayed Fixed During the Day. Anesth Analg. 2012;115(6):1384-1392.
30. Haynes AB, Weiser TG, Berry WR, et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. N Engl J Med. 2009;360(5):491-499.
31. Kopelman Y, Lanzafame RJ, Kopelman D. Trends in Evolving Technologies in the Operating Room of the Future. JSLS. 2013;17(2):171-173.
32. Health Care Financial Management Association (HCFMA). Achieving Operating Room Efficiency through Process Integration.; 2005.
33. Macario A, Vitez TS, Dunn B, McDonald T. Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology. 1995;83(6):1138-1144.
34. Guerriero F, Guido R. Operational research in the management of the operating theatre: A survey. Health Care Manag Sci. 2011;14(1):89-114.
35. Peters JA, Dean HM. Enhancing OR capacity and utilization. Healthc Financ Manage. 2011;65(1):66-71.
36. Macario A. What does one minute of operating room time cost? J Clin Anesth. 2010;22(4):233-236.
37. Shippert RD. A Study of Time-Dependent Operating Room Fees and How to save $100 000 by Using Time-Saving Products. Am J Cosmet Surg . 2005;22(1):25-34.
38. Krupka DC, Sandberg WS. Operating room design and its impact on operating room economics. Curr Opin Anaesthesiol. 2006;19(2):185-191.
2. Barbagallo S, Corradi L, de Ville de Goyet J, et al. Optimization and planning of operating theatre activities: an original definition of pathways and process modeling. BMC Med Inform Decis Mak. 2015;15(1):38.
3. Cardoen B, Demeulemeester E, Beliën J. Operating room planning and scheduling: A literature review. Eur J Oper Res. 2009;201:921-932.
4. Girotto JA, Koltz PF, Drugas G. Optimizing your operating room: Or, why large, traditional hospitals don’t work. Int J Surg. 2010;8(5):359-367.
5. Li D, Wang S, Powers C. A systematic strategy for perioperative process improvement. In: IIE Annual Conference and Expo 2013. ; 2013:626-634.
6. Meredith JO, Grove AL, Walley P, Young F, Macintyre MB. Are we operating effectively? A lean analysis of operating theatre changeovers. Oper Manag Res. 2011;4(3-4):89-98.
7. Weinbroum AA, D M, Ekstein P, D M, Ezri T, D M. Efficiency of the operating room suite. 2003;185:244-250.
8. Sandberg WS, Daily BA, Egan M, et al. Deliberate Perioperative Systems Design Improves Operating Room Throughput. Anesthesiology. 2005;103:406-418.
9. Kurmann A, Tschan F, Semmer NK, Seelandt J, Candinas D, Beldi G. Human factors in the operating room - The surgeon’s view. Trends Anaesth Crit Care. 2012;2(5):224-227.
10. Matern U, Koneczny S. Safety, hazards and ergonomics in the operating room. Surg Endosc. 2007;21(11):1965-1969.
11. Berguer R. Surgery and ergonomics. Arch Surg. 1999;134(9):1011-1016.
12. King PH, Fries RC, Johnson AT. Design of Biomedical Devices and Systems. CRC Press, Taylor & Francis Group,; 2015.
13. Burlington DB. Human factors and the FDA’s goals: Improved medical device design. Biomed Instrum Technol. 1996;30(2):107-109.
14. Lakbala P, Sobhani G, Lakbala M, Inaloo KD, Mahmoodi H. Sharps injuries in the operating room. Environ Health Prev Med. 2014;19(5):348-353.
15. Bharathan R, Aggarwal R, Darzi A. Operating room of the future. Best Pract Res Clin Obstet Gynaecol. 2013;27(3):311-322.
16. Klein M, Andersen LPH, Alamili M, Gögenur I, Rosenberg J. Psychological and Physical Stress in Surgeons Operating in a Standard or Modern Operating Room. Surg Laparosc Endosc Percutan Tech. 2010;20(4):237-242.
17. Kenyon TAG, Urbach DR, Speer JB, et al. Dedicated minimally invasive surgery suites increase operating room efficiency. Surg Endosc. 2001;15(10):1140-1143.
18. Garbey M, Joerger G, Huang A, et al. An intelligent hospital operating room to improve patient health care. J Comput Surg. 2015;2(1):3.
19. Nundy S, Mukherjee A, Sexton JB, et al. Impact of Preoperative Briefings on Operating Room Delays. Arch Surg. 2008;143(11):1068.
20. Porta CR, Foster A, Causey MW, et al. Operating room efficiency improvement after implementation of a postoperative team assessment. J Surg Res. 2013;180(1):15-20.
21. Tadeo JR. Improving Operating Room Efficiency: A Quality Improvement Project. 130, 910-917 (2014).
22. Doll D, Wieferich K, Erhart T, Hoenemann C. Waiting for Godot. Eur J Anaesthesiol. 2014;31(7):388-389.
23. Dexter F, Epstein RH, Marcon E, Ledolter J. Estimating the incidence of prolonged turnover times and delays by time of day. Anesthesiology. 2005;102(6):1242-8;
24. STAHL J, SANDBERG W, DAILY B, et al. Reorganizing patient care and workflow in the operating room: a cost-effectiveness study. Surgery. 2006;139(6):717-728.
25. Hanss R, Buttgereit B, Tonner PH, et al. Overlapping induction of anesthesia: an analysis of benefits and costs. Anesthesiology. 2005;103(2):391-400.
26. Torkki PM, Marjamaa RA, Torkki MI, Kallio PE, Kirvelä OA. Use of anesthesia induction rooms can increase the number of urgent orthopedic cases completed within 7 hours. Anesthesiology. 2005;103(2):401-405.
27. Doll D, Kauf P, Wieferich K, Schiffer R, Luedi MM. Implications of Perioperative Team Setups for Operating Room Management Decisions. Anesth Analg. 2017;124(1):262-269.
28. Stepaniak PS, Vrijland WW, de Quelerij M, de Vries G, Heij C. Working With a Fixed Operating Room Team on Consecutive Similar Cases and the Effect on Case Duration and Turnover Time. Arch Surg. 2010;145(12):1165.
29. Stepaniak PS, Heij C, Buise MP, Mannaerts GHH, Smulders JF, Nienhuijs SW. Bariatric Surgery with Operating Room Teams that Stayed Fixed During the Day. Anesth Analg. 2012;115(6):1384-1392.
30. Haynes AB, Weiser TG, Berry WR, et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. N Engl J Med. 2009;360(5):491-499.
31. Kopelman Y, Lanzafame RJ, Kopelman D. Trends in Evolving Technologies in the Operating Room of the Future. JSLS. 2013;17(2):171-173.
32. Health Care Financial Management Association (HCFMA). Achieving Operating Room Efficiency through Process Integration.; 2005.
33. Macario A, Vitez TS, Dunn B, McDonald T. Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology. 1995;83(6):1138-1144.
34. Guerriero F, Guido R. Operational research in the management of the operating theatre: A survey. Health Care Manag Sci. 2011;14(1):89-114.
35. Peters JA, Dean HM. Enhancing OR capacity and utilization. Healthc Financ Manage. 2011;65(1):66-71.
36. Macario A. What does one minute of operating room time cost? J Clin Anesth. 2010;22(4):233-236.
37. Shippert RD. A Study of Time-Dependent Operating Room Fees and How to save $100 000 by Using Time-Saving Products. Am J Cosmet Surg . 2005;22(1):25-34.
38. Krupka DC, Sandberg WS. Operating room design and its impact on operating room economics. Curr Opin Anaesthesiol. 2006;19(2):185-191.
Downloads
Published
2019-09-13
Issue
Section
Research Article
