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Surgery. 2006 Oct;140(4):509-14; discussion 514-6. Epub 2006 Aug 28.

Improving operating room efficiency through process redesign.

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  • 1Department of Anesthesiology, MetroHealth Medical Center, Case School of Medicine, Cleveland, Ohio, USA.



Operating rooms (ORs) are important resources for patient care and revenue, yet a significant portion of OR time is taken up by nonoperative activities. We hypothesized that redesigning the process that occurs between operations would lead to a decrease in nonoperative time (NOT = room turnover time plus anesthesia induction and emergence time).


Following a 3-month multidisciplinary planning process, a prospective study to reduce NOT was initiated in 2 of 17 ORs at a tertiary care academic medical center. Unlike previous reports, which have limited the number of participants, we constructed a process that was restricted only by case duration. The plan focused on minimizing nonoperative tasks in the OR, effecting parallel performance of activities, and reducing nonclinical disruptions. Eligible cases were those with an estimated operative time of 2 hours or less. A target NOT of 35 minutes was established. Cases of similar duration in the remaining ORs served as a concurrent control group.


Twenty-three surgeons, 13 anesthesiologists, and 11 nurses worked in the project ORs over a 3-month period. Residents participated in all cases. There was a significant reduction in NOT (42.2 +/- 12.9 vs 65 +/- 21.7 minutes), turnover time (26.4 +/- 11.2 vs 42.8 +/- 21.7 minutes), and anesthesia-related time (16.9 vs 21.9 minutes, all P < .001) in the project rooms compared with cases of similar duration in control ORs. Process-related delays were identified in 70% of cases when NOT exceeded the 35-minute target.


These results demonstrate that a coordinated multidisciplinary process redesign can significantly reduce NOT. This process is applicable to most ORs and has optimal benefit for cases of 2 hours or less in duration. The high percentage of residual process-related delays suggests that further improvements can be anticipated.

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