title: High-throughput operating room system for joint arthroplasties durably outperforms routine processes.
abstract: BACKGROUND
  Recent publications have focused on increased operating room (OR) throughput without increasing total OR time. The authors hypothesized that a system of parallel processing for lower extremity joint arthroplasties sustainably reduces nonoperative time and increases throughput.
  
  
  METHODS
  The high-throughput parallel processing strategy included neuraxial anesthesia performed in an "induction room" adjacent to the OR, patient selection, an additional circulating nurse, and end-of-case transfer of care to a recovery room nurse who transported the patient from the OR to recovery. Instruments and supplies were prepared in a dedicated sterile setup area. Data were extracted from administrative databases. Group comparisons used standard statistical methods; statistical process control was used to evaluate performance over time.
  
  
  RESULTS
  There were 688 historic control cases from 299 days over 16 months, and 905 high-throughput cases from 304 days spanning 24 consecutive months starting September 1, 2004. Throughput increased from 2.6 +/- 0.7 (mean +/- SD) to 3.4 +/- 0.8 arthroplasties per day per room. Nonoperative time decreased by 36 min (or 50%) per case. Operative time also decreased by 14 min (12%) per case. The end time for the high-throughput OR day was only 16 min later than control. Nonoperative time, operative time, and throughput remained significantly improved after 2 yr of operation. Contribution margin increased 19.6%.
  
  
  CONCLUSIONS
  Reorganizing the perioperative work process for total joint replacements sustainably increased OR throughput. Because joint arthroplasties generated a positive margin greater than the incremental cost, the high-throughput system improved financial performance.
authors.affiliation: Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Smith
authors.forename: Warren S
authors.initials: WS
authors.lastname: Sandberg
authors.forename: Joseph
authors.initials: J
authors.lastname: Foss
authors.forename: Kathleen
authors.initials: K
authors.lastname: Massoli
authors.forename: Mona
authors.initials: M
authors.lastname: Kanda
authors.forename: Wael
authors.initials: W
authors.lastname: Barsoum
authors.forename: Armin
authors.initials: A
authors.lastname: Schubert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D001071:Appointments and Schedules; D001178:Arthroplasty / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D010564:Personnel, Hospital / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D017748:Time Management / Q000191:economics / Q000379:methods