Operating room design and its impact on operating room economics.

PURPOSE OF REVIEW: Operating rooms are high-cost/high-revenue environments. In an era of rising costs and declining reimbursement, it is essential to optimize the effectiveness of the operating room suite, maximizing throughput of profitable cases while minimizing the costs of necessary, but unprofitable, procedures. RECENT
FINDINGS: Operating room management focuses on reducing wasted time in order to perform more cases in regular business hours, reduce overtime, or provide a better experience for staff and patients. It has been difficult to improve perioperative efficiency enough to reliably add cases during regular hours because the required time savings are so large, while most interventions can save only a few minutes per case. Recent work, however, has changed the basic paradigms for turning over operating rooms, dramatically reducing nonproductive time and increasing operating room throughput. In some situations, the additional expense required to achieve throughput improvements is more than offset by financial gains.
SUMMARY: Redesigning perioperative systems can increase operating room throughput, but not all case mixes benefit from the required additional resources. Thus hospitals should choose judiciously if, and to what degree, high throughput environments are implemented. Once implemented, access to these environments can be used as an incentive for improved surgical performance.