Operating Room Takeoffs

November 1, 2011

It’s 0730 on any given morning and the flight pattern is full. Numerous stretchers, with patients on board, pull out of their holding rooms and taxi down the hall to their respective operating theatres.

Hospital administrators are always looking to improve OR efficiency as it represents a huge cost center in any hospital. At least at all the places I’ve ever operated, ORs all start at the same time in the morning. That would be ok if anesthesia attendings could simultaneously start 3 or 4 rooms right at 730, but that’s never the case and therefore you often end up waiting.

The problem, I think, is that administrators focus on the wrong metric….the In-Room time. The goal at all of these places is to have the patient in the room at or before the OR start time. In-room time does not readily reflect the time at which the work of the case can actually commence. All of that depends on the anesthesia-ready time. Once anesthesia is ready, then the operative team can proceed with positioning, prepping, draping, and eventually incision.

One of the variables that I don’t think is ever accounted for by administration is that the time required to position and prep a patient for an operation varies significantly from procedure to procedure. For example, a cystoscopy versus an open partial nephrectomy.

In my opinion, the most important metric that administrators need to pay attention to is: Incision time. Hospitals are paid technical fees for the procedures they perform, not necessarily the time patients spend in the OR. ORs need to be kept “in the air” just like airlines try to do with their planes. They lose money with the birds on the ground.

Airlines have at least learned that all planes don’t push back from the gate at 0730 just for most of the planes to wait on the tarmac for their time to takeoff. ORs should start in a staggered fashion to maximize efficiency.

Just a few thoughts.