Operating Room Efficacy

Operating Room Efficacy


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This section offers an analysis of available literature about operating room efficacy, and seeks to summarize the literature on the major problems experienced in operating rooms, and their proposed solutions. This review of literature will lead to the development of novel insights regarding the research topic.


The Operating Room


The operating room is supported trough a central location that is within or nearby the OR, and it is known as “core.” The core is usually physically limited through its storage space and as a result, it is resupplied periodically from a huge on-site storage and central processing location (Harper, 2002). The core sustains the operating rooms with the needed inventory for each procedure. Central procession holds an extensive variety of materials, and it serves as preparation region to organized, and develops procedure-specific kits. The kits are groups of items that are common to a certain surgeon’s procedure. The specific stuff contained in a kit are infrequently standardized and their specifications are done by individual surgeons (Marjamaa & Kirvela, 2007) .


Central procession carries materials in either prepared or unprepared form and it is resupplied from a supply base that holds different vendors. Rappold et al.(2011) ascertains that materials planning in the operating room calls for high availability of expensive stuff in spatially controlled locations, and in existence of nonstationary, uncertain demand. The materials differ through cost, perishability and short-term demand uncertainty. Demand indecision occurs because the needed material for a patient procedure depends on both the surgeon and the patient. The distinctive needs of the surgeon and the patient preferences for materials and the real consumption of these materials through the surgeon in the course of the treatment can vary for each surgeon and each patient. Additionally, the planning of surgeons and their services instigates huge peaks in demand procedures for the material. Figure 1 shows material flow from vendors to ORs


Figure 1: Material Flow


Note: From Rappold et al. (2011). An inventory optimization model to support operating room schedules. Supply Chain Forum, 12 (1), p.60


Inadequate material availability instigates delays that may lead to numerous undesirable upshots, which include:


Additional cost of labor linked to preparation, transportation and handling of emergency Replacements from external sources or central processing


Increased expedited shipment costs from external suppliers


Postponement of patient treatment and physician capacity to a prospective time


Great change in the condition of the patient.


Operating rooms tries to attain increased availability rate through stocking huge amounts of inventory thereby incurring increased carrying cost and rendering the system to financial risk while labor, space and financial resources remain constrained.


Operating Room Management


According to Plaster, Seagul & Xiao (2003), operating room management calls for the coordination of material and human resources in a manner that allows for efficient performance of surgeries. Operating room management ensures safe and cost effective surgeries. Yearly cost approximations for surgical errors were between 8.5 and 17 billion dollars in 1999, with most medical errors linked to system-linked errors, which included coordination breakdowns (Plaster, Seagul & Xiao, 2003). Managing a well-organized operating room plan take into consideration safe practice, staff satisfaction and containment within a framework of constant change and reduction of over-used operating room time. Plaster, Seagul & Xiao (2003) confirmed that augmented number of surgical clients getting out — patient care requires increased management efforts trough operating room personnel in coordinating daily operations.


Plaster, Seagul & Xiao (2003) asserts that decisions that involve operating room coordination calls for participation from multi-disciplinary stakeholders. Interdisciplinary consensus and partnership from major players is attainable through prevention of formal or hierarchical power structures, devoted to ensuring collective responsibility and equality besides operating for goals’ attainment. Findings from past studies indicated that participants within settings where disbursement of planning among scores of persons occur, distributed team organizations are practicable (Macario, 2006). In such areas, a single decision holds multiple effects thus making well-managed decisions to be paramount. In particular, in areas of an operating room, there are numerous stakeholders each holding access to crucial information regarding the operating room management. Plaster, Seagul & Xiao (2003) confirms that communication technology and computation hold the ability to enhance group decision-making, achieve satisfaction of staff, promote provision of secure patient care and augment efficiency. However, recognition of this potential calls for deep comprehension of group-decision making process, and the potential effect the computerized decision-making tools have on the system.


Rappold et al. (2011) assert that costs of health care are constantly increasing at unprecedented rates in the United States. Rappold and his associates confirmed that previous studies have tackled the optimal patient scheduling to promote the effective use of operating theater resources. They however, confirmed that little study has tried to optimize material and safety stocks to enhance the optimized schedules. Based on Rappold et al.(2011) research findings, great prospects are available that allows reduction of waste through enhancing the coordination and planning of information and materials in hospitals’ operating rooms. According to Rappold et al.(2011), Canadians and Greek citizens spend an average of 2, 300 and 3, 300 U.S. dollars yearly per capita on cost of health care, while United States citizens consumes over 6, 000 U.S. dollars per capita. There is proof that particular costs are increasing at a fast rate compared to others.


Rappold et al. .(2011) reported the fastest growing standard yearly hospital cost rates between 2000 and 2002, where operating rooms costs rose at a 32% rate, medical supplies at 22%, intensive care at 27% and diagnostic imaging at a rate of 36%. According to Rappold et al. (2011), the rising costs in operating rooms are triggered by inappropriate decision-making strategies where hospital material managers make decisions through burn up feeling as opposed to a structured decision process. Increased material availability rates and high cost of materials are attainable through regular expediting and stocking of excessive quantities (Santibanez, Begen & Atkins, 2007). There are major prospects that are available and that would help in lowering waste through enhancing the coordination and planning of information and materials in hospitals’ operating rooms.


Increasing Operating Room Efficacy


For operating rooms to effective, Rappold et al. (2011) asserts that improved perspectives to coordinate hospital inventories and improved information sharing are paramount. The operating room stock inventory is critical to manage with respect to availability and cost (Macario, 2006). According to Peltokorpi (2011), surgical Ors are cost-intensive portions of health service production. Controlling operating units productively is crucial when healthcare systems and hospitals aims at maximizing health upshots with restrained resources. The pressure to promote health while spending less money compels healthcare facilities to search for novel ways of planning the service. Surgical operating room provides forty percent of a hospital’s total revenues and a similarly huge proportion of it overall expenses (Peltokorpi, 2011). Peltokorpi (2011) stresses on the need for formation of an overall production plan, detailed planning of material needs and capacity and the implementation of these plans. He confirms the significance of putting into consideration the balance amid the level of use of resources and availability of services.


Fixed capacity allocation and facilities planning are essential in management of resources and time in operating rooms (Dexter et al. (2006). The conventional materials-driven planning logic in most hospitals ORs hold disadvantages. Based on the reports of the study carried out by Peltokorpi (2011), appropriate operative practices are more significant compared to cored strategic decisions with respect to performance improvement in operating rooms. This provides a good prospect for operating unit when executing novel operative practices is easier compared to shifting strategic orientation. The results from the study indicated that increased productivity in OR entails combination of low idle time per operation, high-speed surgery and lean personnel intensity.


Rappold et al.(2011) claims that the materials management issues that arise in most hospitals are made more intricate through nonstationary and stochastic temperament of individual stuff demands. While most surgical procedures are planned weeks earlier, a client’s condition and material needs may change at any point following diagnosis or in the course of the surgical procedure. Materials managers cannot predetermine the daily emergency surgical processes correctly. This forms the two sources of demand ambiguity and they functions to generate vey high demand insecurity in operating rooms. The demand uncertainty and the need to ensure efficacy in operating rooms calls for proper management of OR supplies.


Information sharing is also paramount. According to Butler et al.(2012), information systems offer only a fraction of data needed to sufficiently coordinate the shifting schedule of the operating room. The concerned personnel depend upon information sources and according to findings from the research carried out by Plasters; Seagull & Xiao (2003), direct observation by charge nurse is a dependable technique that facilitates determination of relevant scheduling. However, this observation requires a lot of effort and time. In this regard, information tools that support management in a collaborative and dynamic system such as OR suite calls for inclusion of applications and technologies that facilitate social networking, real-time and direct, systems status perception. For instance, the employment of remote viewing of major component of operating room system through video signal helps in direct real-time system status perception. Communication technology also fosters social networks while communal exhibits foster collaborative work.


The only means through which hospitals can reduce costs and generate profits is through improving the effectiveness of inventory management (Harper, 2002). The concept that supplies are at the place of their use only when required prevents excess inventory, however, this concept leads to more time spent in operating rooms where nurses frequently goes to look for supplies. Moreover, this trend increases cost to patients, affects staff productivity in operating and may worsen the condition of patients due to ineffective surgical procedures. Peltokorpi (2011) suggest that hospitals should in increase their level of staffing to create efficiency in operating rooms. He affirms that, more attention should be channeled to disparities in personnel management and levels of staffing.


Productivity could be greatly augmented in all hospital units if more attention is focused on staffing (Wright, Bretthauer & Ceot’e, 2006). According to Anonymous (1996), to increase operating room efficient, hospitals should adopt TracePak system that lowers costs and offers required supplies at point of service. This system reduces inventory, lowers cost creates more spaces for operating procedures. Identification of the first steps in recognizing probable cost reductions in hospitals entails detection of departments that use-up more resources. Operating room is among those units that utilizes many resources. To cut cost in operating rooms, the hospital management should train the OR staff and surgeons concerning supplies cost and create clinical pathways that facilitates provision of optimal care at reduced cost. On the other hand, Berry, Berry-stolzle & Schleppers (2008) assert that suitable scheduling behavior, management techniques and operating room capacity facilitates efficiency in operating room.


According to Berry, Berry-stolzle & Schleppers (2008), hospital size and operating room space is the chief forecaster of productivity in operating room. While managers cannot change the hospital size to augment efficiency in operating room, executing fundamental management techniques which include controlling and planning, are crucial to increase the efficiency and performance of operating room staff (Krupka & Sandberg, 2006) .Weekly planning of surgeries makes the operating room unable to respond to shifts intrinsic in the operating room on daily basis. Daily planning is practical, but is subject to shifts particularly towards culmination of surgical working day. The cooperative setting according to Lehtonen, Torkki, Peltokorpi & Moilanen (2009) does not instigate increased productivity, but the use of a management tool that side with interests of the staff and patient enhances performance in operating rooms. As a result, productivity in operating room is linked to proper management methods, suitable planning and management techniques that correspond to interests of patients and those of operating room staff.




Coordinating the surgical procedure in operating suite, the most costly department in a hospitals, is crucial, but challenging (Marjamaa & Kirvela, 2007). While practical management can promote productivity in operating room, indistinguishable managerial structures can impede the most advantageous deployment of resources. Hospitals should engage more focus on communication and collaboration between care providers. Moreover, hospitals should increase the capacity of operating rooms, engage proper planning, adopt excellent management and avoid advance over-planning to increase productivity in operating rooms. According to Fredendall (2009), hospitals should also incorporate variable that measure supply coordination.




Anonymous. Community hospitals of California cuts 20% from its supply budget in the operating room with custom procedure trays. (1996). Hospital Materials Management, 21(2), 10-10.


Anonymous. Trend is down in cost per case in the operating room, but there is still room for driving out more cost; here’s how. (1996). Hospital Materials Management, 21(3), 22-22.


Berry, M., Berry-stolzle, T., & Schleppers, A. (2008). Operating room management and Butler et al. (2012), Applying science and strategy to operating room workforce management. Nursing Economics, 30(5), 275-281.


Dexter et al. (2006). Mean operating room times differ by 50% among hospitals in different countries for laparoscopic cholecystectomy and lung lobectomy. Journal of Anesthesia, 20, 319-322.


Fredendall, L. (2009). Barriers to swift, even flow in the internal supply chain of preoperative surgical services department: A case study. Decision Sciences, 40 (2), 327, 349.


Harper, P. (2002). A framework for operational modeling of hospital resources. Health Care Management Sciences, 5, 165-173.


Krupka D, Sandberg W. (2006) Operating room design and its impact on operating room economics. Curr Opin Anaesthesiol, 19 (2):185 — 191.


Lehtonen, J-M; Torkki, P; Peltokorpi, A; Moilanen, T. (2009).How to increase productivity by improving scheduling in operating rooms? EUROMA conference Goteborg, Sweden, June 2009.


Macario A. (2006). Are your hospital operating rooms “efficient”?: A scoring system with eight performance indicators. Anesthesiology, 105:237 — 240.


Marjamaa, R., & Kirvela, O. (2007). Who is responsible for operating room management and how do we measure how well we do it? Abta Anaestesiol Scand, 51, 809-814.


operating room productivity: The case of Germany. Health Care Management Science, 11(3), 228-39.


Peltokorpi, A. (2011). How do strategic decisions and operative practices affect operating room productivity. Health care management Science, 14 (4), 370-382.


Plasters, CL, Seagull, FJ., & Xiao, Y.(2003). Coordination Challenges in Operating-Room Management: An In-Depth Field Study. AMIA Annual Symposium Proceeding Archive, 524, 528.


Rappold et al. (2011). An inventory optimization model to support operating room schedules. Supply Chain Forum, 12 (1), 56-69.


Santibanez P, Begen M, Atkins D. (2007). Surgical block scheduling in a system of hospitals: an application to resource and wait list management in a British Columbia health authority. Health Care Manage Sci, 10:269 — 282.


Wright, P.D., Bretthauer, K.M., & Ceot’e, M.J. (2006). Reexamining the nurse scheduling problem: Staffing ratios and nursing shortages. Decision Science, 37(1), 39 — 7.

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