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

Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Surgery (Impact Factor: 3.38). 06/2006; 139(6):717-28. DOI: 10.1016/j.surg.2005.12.006
Source: PubMed


Many surgeons believe that long turnover times between cases are a major impediment to their productivity. We hypothesized that redesigning the operating room (OR) and perioperative-staffing system to take advantage of parallel processing would improve throughput and lower the cost of care.
A state of the art high tech OR suite equipped with augmented data collection systems served as a living laboratory to evaluate both new devices and perioperative systems of care. The OR suite and all the experimental studies carried out in this setting were designated as the OR of the Future Project (ORF). Before constructing the ORF, modeling studies were conducted to inform the architectural and staffing design and estimate their benefit. In phase I a small prospective trial tested the main hypothesized benefits of the ORF: reduced patient intra-operative flow-time, wait-time and operative procedure time. In phase II a larger retrospective study was conducted to explore factors influencing these effects. A modified process costing method was used to estimate costs based on nationally derived data. Cost-effectiveness was evaluated using standard methods.
There were 385 cases matched by surgeon and procedure type in the retrospective dataset (182 ORF, 193 standard operating room [SOR]). The median Wait Time (12.5 m ORF vs 23.8 m SOR), Operative Procedure Time (56.1 m ORF vs 70.5 m SOR), Emergence Time (10.9 m ORF vs 14.5 m SOR) and Total Patient OR Flowtime (79.5 m ORF vs 108.9 m SOR) were all shorter in the ORF (P < .05 for all comparisons). The median cost/patient was $3,165 in the ORF (interquartile range, $1,978 to $4,426) versus $2,645 in SORs (interquartile range, $1,823 to $3,908) (P = ns). The potential change in patient throughput for the ORF was 2 additional patients/day. This improved throughput was primarily attributable to a marked reduction in the non-operative time (ie, those activities commonly accounting for "turnover time") rather than facilitation of faster operations. The incremental cost-effectiveness ratio of ORF was $260 (interquartile range, $180 to $283).
The redesigned perioperative system improves patient flow, allowing more patients to be treated per day. Cost-effectiveness analysis suggests that the additional costs incurred by higher staffing ratios in an ORF environment are likely to be offset by increases in productivity. The benefits of this system are realized when performing multiple, short-to-medium duration procedures (eg, <120 m).

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Available from: James E Stahl, Oct 09, 2015
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    • "In most cases, those records are usually limited to just a few metrics of the surgical process such as waiting time, surgery time or recovery time. Studies focused on improving the efficiency of using OTs, and reducing waiting lists of patients, need a large amount of data to find significant results (Stahl et al., 2006; Torkki et al., 2006). Some authors have dedicated most of the project period to data collection in order to have enough data to implement realistic models (Denton et al., 2007). "
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    ABSTRACT: Purpose ‐ The purpose of this paper is to provide a framework for analysing and modelling detailed workflow of image-guided interventions to facilitate simulation and the re-engineering process for the development of new procedures in multi-modal imaging environments. Design/methodology/approach ‐ The methodology presented includes a literature review on workflow simulation in surgery, focussing on radiology environments, an assessment of simulation tools, a data gathering and management framework and research on methods for conceptual modelling of the processes. Findings ‐ The literature review reveals that few authors attempted to analyse the phases within image-guided interventions, and those that did, only did so partially. The framework developed for this work intends to fill the gap found in the survey. It allows the maintenance and management of large amounts of data, one of the most critical factors when modelling detailed workflow. In addition, selecting the appropriate simulation software plays an important role, saving time in later stages of the project. Originality/value ‐ The framework presented for endovascular interventions can be extended to other types of image-guided interventions. Moreover, modelling the workflow processes in a modular way facilitates the re-engineering process when integrating different imaging modalities during the same procedure.
    Journal of Enterprise Information Management 02/2013; 26(1/2):75-90. DOI:10.1108/17410391311289550
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    • "Our data suggest that difficult venous access in bariatric surgery patients may contribute to OR delays. With operating room cost per minute on the order of $15–25 [32] and with an average $66 per minute charged to patients, [33] a savings of 15 minutes per case can have a significant financial impact at the hospital level, especially when a single attending anesthesiologist oversees two, three, or even four rooms at one time. Moreover, each such delay avoided will prevent accumulating costs for subsequent patients' scheduled in the same operating room. "
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    07/2012; 2012(3):816871. DOI:10.5402/2012/816871
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    • "actions at assessment, treatment, post-treatment, and discharge, and underlying beliefs about these actions and the situation) [18-23]; (iii) organisational factors (e.g. patient pathways, service and staff structures, organisational procedures and resources) [17,18,21-24]; and (iv) system and ecological factors (e.g. methods for financing health services, location and availability of public transport) [18,25]. "
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