title: Deliberate perioperative systems design improves operating room throughput.
abstract: BACKGROUND
  New operating room (OR) design focuses more on the surgical environment than on the process of care. The authors sought to improve OR throughput and reduce time per case by goal-directed design of a demonstration OR and the perioperative processes occurring within and around it.
  
  
  METHODS
  The authors constructed a three-room suite including an OR, an induction room, and an early recovery area. Traditionally sequential activities were run in parallel, and nonsurgical activities were moved from the OR to the supporting spaces. The new workflow was supported by additional anesthesia and nursing personnel. The authors used a retrospective, case- and surgeon-matched design to compare the throughput, cost, and revenue performance of the new OR to traditional ORs.
  
  
  RESULTS
  For surgeons performing the same case mix in both environments, the new OR processed more cases per day than traditional ORs and used less time per case. Throughput improvement came from superior nonoperative performance. Nonoperative Time was reduced from 67 min (95% confidence interval, 64-70 min) to 38 min (95% confidence interval, 35-40 min) in the new OR. All components of Nonoperative Time were meaningfully reduced. Operative Time decreased by approximately 5%. Hospital and anesthesia costs per case increased, but the increased throughput offset costs and the global net margin was unchanged.
  
  
  CONCLUSIONS
  Deliberate OR and perioperative process redesign improved throughput. Performance improvement derived from relocating and reorganizing nonoperative activities. Better OR throughput entailed additional costs but allowed additional patients to be accommodated in the OR while generating revenue that balanced these additional costs.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA. wsandberg@partners.org
authors.forename: Warren S
authors.initials: WS
authors.lastname: Sandberg
authors.forename: Bethany
authors.initials: B
authors.lastname: Daily
authors.forename: Marie
authors.initials: M
authors.lastname: Egan
authors.forename: James E
authors.initials: JE
authors.lastname: Stahl
authors.forename: Julian M
authors.initials: JM
authors.lastname: Goldman
authors.forename: Richard A
authors.initials: RA
authors.lastname: Wiklund
authors.forename: David
authors.initials: D
authors.lastname: Rattner
mesh_terms: D000758:Anesthesia; D001071:Appointments and Schedules; D005160:Facility Design and Construction; D006801:Humans; D009873:Operating Rooms / Q000191:economics / Q000458:organization & administration*; D013997:Time Factors