title: A "swing room" model based on regional anesthesia reduces turnover time and increases case throughput.
abstract: OBJECTIVE
  Our centre recently implemented a new ambulatory care model featuring two alternate regional anesthesia "swing" operating rooms (RA-SRs) managed by a single anesthesiologist. We hypothesized that this model would be associated with decreased turnover times and improved recovery profiles when compared with a traditional model with a single operating room using general anesthesia.
  
  
  METHODS
  We conducted a retrospective cohort study of 164 patients scheduled for hand and wrist surgery who were treated in the RA-SRs under brachial plexus blockade, and we compared the findings with a matched historical control group of patients who underwent general anesthesia in a single operating room (GA-OR). The primary endpoint was room turnover time. Secondary endpoints included home discharge time, postoperative interventions for nausea and pain, and number of cases possible per eight-hour day.
  
  
  RESULTS
  Patients in the RA-SR group had faster turnover times than patients in the GA-OR group (median [interquartile range]: 15 min [8-22] vs 54 min [49-61], respectively) as well as faster home discharge times (28 min [20-46] vs 156 min [118-215], respectively) (P < 0.0001). In the RA-SR group, postoperative antiemetics were used in 3/164 patients (2%) vs 28/164 (17%) in the GA-OR group (P < 0.0001), and opioids were used in 1/164 (0.6%) vs 132/164 (80%), respectively (P < 0.0001). The median number of daily cases possible in the RA-SR group was 56% greater than in the GA-OR group (8.4 [7.5-9.4] vs 5.4 [5.1-5.8], respectively; P < 0.0001).
  
  
  CONCLUSIONS
  Compared with a traditional model using general anesthesia in a single operating room, the implementation of a model using regional anesthesia with two swing operating rooms was associated with reduced room turnover times, improved recovery profiles, and a higher case throughput.
authors.affiliation: Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada. steevhead@yahoo.ca
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Head
authors.forename: Rachael
authors.initials: R
authors.lastname: Seib
authors.forename: Jill A
authors.initials: JA
authors.lastname: Osborn
authors.forename: Stephan K W
authors.initials: SK
authors.lastname: Schwarz
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000765:Anesthesia, Conduction / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D000932:Antiemetics / Q000627:therapeutic use; D001917:Brachial Plexus; D015331:Cohort Studies; D005260:Female; D006225:Hand / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009407:Nerve Block / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D014953:Wrist / Q000601:surgery
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000932:Antiemetics