High-throughput Operating Room System for Joint Arthroplasties Durably Outperforms Routine Processes

• Published in: Anesthesiology (Philadelphia) 2008-07, Vol.109 (1), p.25-35
• Main Authors: SMITH, Michael P, SANDBERG, Warren S, FOSS, Joseph, MASSOLI, Kathleen, KANDA, Mona, BARSOUM, Wael, SCHUBERT, Armin
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anesthesia - economics; Anesthesia - methods; Anesthesia - utilization; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Appointments and Schedules; Arthroplasty - economics; Arthroplasty - methods; Arthroplasty - utilization; Biological and medical sciences; Efficiency, Organizational - economics; Female; Humans; Male; Medical sciences; Middle Aged; Operating Rooms - economics; Operating Rooms - methods; Operating Rooms - utilization; Personnel, Hospital - economics; Personnel, Hospital - utilization; Retrospective Studies; Time Factors; Time Management - economics; Time Management - methods
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0b013e31817881c7

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. 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. 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%. 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.