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Increasing Operating Room Efficiency and Flow-Thru Logistics

Achieving Better Prep, Execution, and Discharge in the OR

By Denice Soyring Higman

By Adam Higman

By Dragana Gough


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Pre-Operative Phase

The OR should run like a well-oiled machine with patients moving through each stage seamlessly as the slightest factor can have lasting negative effects.  As with most things, the process of improvement must start at the beginning with Pre-admission Preparation.  Ensuring that patient files have an up-to-date History and Physical (H&P) and Laboratory and Radiology reports, as well as financial clearance will aid in the improvement process.

Some Vital Queries

One of the keys to improving preoperative performance is involving physicians. Assess where things stand by asking these questions:

  • Is Anesthesia involved in team decision making?
  • Are Medical Staff taking an active role in throughput?
  • Is your Anesthesia staff reviewing patient charts for the next day?
  • Anesthesia staff should assess a scheduled patient when the health history suggests potential problems

Holding Area or Not?

It depends.  Most hospitals do not use holding areas for all patients, even though the areas may exist.  Typical uses for holding areas include inpatient surgery patients and anesthesia services for line insertions, etc.  For smoother transitions in the OR, you should consider elimination of multiple stops for outpatients.

Operative Phase

Operative throughput should start with an assessment of your instrument and supplies. This begins with a review of your case cart readiness, including the number of trays and instruments, used and unused.  The goal of this review is to eliminate any additional unneeded instrument counting/processing.  To avoid case delays, ensure that all materials and supplies pulled for the case are correct and your preference cards are updated.  As with any procedure, make sure that the equipment is functioning correctly and that all personnel are fully trained for the job.  Perform proper maintenance checks ahead of time and review storage and organization procedures to ensure that the equipment is readily available for the next case start time.  Unreliable items that frequently break/malfunction can have a huge effect on turnover.

Team Approach to Operating Room Turnover

It is imperative that the OR staff be ready to start on time and every person in surgery should have a part of the turnover process.  Surgeons can set the stage for expectations, especially if they are present during turnover/set-up.  Do not let them perform a disappearing act.  Work with surgeon’s office staff on scheduling issues if there continues to be a problem.  For Anesthesia, Scrub, and Circulator staff, create buy-in for quick turnover time, utilize specialty teams, if possible, publicize turnover results (monthly), and celebrate improvements.  Anesthesia can help transport patients from Holding/Day Surgery to OR and housekeeping needs to be readily available to assist with cleanup.  Nursing staff can assist with cleanup of rooms and patient transport.  The bottom line, everyone needs to pitch in whether it is in their “job description” or not.

Post-Operative Phase

To continue the momentum, make strides in post-op procedures starting with discharging from the post-anesthesia care unit (PACU).  Acute care facilities should consider discharging select, low acuity patients directly from PACU.

Pre-Order Now

We are now preparing the next edition of our book: “Healthcare Organizations” [Management Strategies, Tools, Techniques and Case Studies]. In-Process from: (c) Productivity Press 2012


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7 Responses

  1. Hospitals and Healthcare Organizations
    [Management Strategies, Operational Techniques, Tools, Templates and Case Studies]


    In the business of medicine, there are three ways to increase revenue 1) charge more, 2) do more, and/or 3) do the work more efficiently. In the current health care market where reimbursements are decreasing in the face of increasing expenses, a systemized approach is needed to maximize revenue to remain viable in the current health care arena.

    Dr. David Edward Marcinko and Professor Hope Rachel Hetico in their new book, Hospitals and Healthcare Organizations [Management Strategies, Operational Techniques, Tools, Templates and Case Studies] bring their vast healthcare experience along with additional national experts to provide a healthcare model-based framework to allow health care professionals to utilize the checklists and templates to evaluate their own systems, recognize where the weak links in the system are and, applying the well illustrated principles, improve the efficiency of the system without sacrificing quality patient care.

    I first became aware of Dr. Marcinko while doing research for the master’s thesis in my post graduate LL.M. program following graduation from law school. The topic of my thesis was The Anatomy and Psychology of Physician Investments. There was no shortage of literature about the psychology of investing. However, health care professionals in general and physician in particular are more unique in the psychological forces that guide their investing. Dr. Marcinko’s previous book, Financial Planning Handbook for Physicians and Advisors, provided the foundation of physician investing allowing me to add to the discussion by bringing the academic ivory tower discussion into the everyday clinical environment of the physician. Since that time I have benefited from his websites, our correspondences and telephone conversations.

    As nothing in a health care system is isolated unto itself and is co-dependent upon a number of other departments in the system, maximizing efficiency across departments and among different types of health care workers may prove to be a task many are called upon to undertake but few have succeeded. If the number of assets such as hospital beds, operating rooms, ICU suites are fixed then these units must be maximized by working more efficiently to allow these fixed assets to be utilized more within calendar period thus resulting in increase revenue generation.

    My wife and I recently experienced a health care delivery system that could have been detailed as a case history in this book. She had a total knee arthroplasty done by the doctor’s doctor in joint replacement in Florida. This physician does 1,000 total joints a year operating only three days a week. Doing the math you can see he does on average 6 plus joints a day, three days a week, 52 weeks a year. The procedures take on average about two hours, his patients are up walking within one hour of arriving from the recovery room and spend two-three nights in the hospital. The surgeon rounds every morning at 5 a.m. with the head nurse, the head of physical therapy, the discharge planner and his physician assistant to assure everything is done to maximize the patient’s recovery while utilizing the hospital’s resources efficiently. With an average surgeon’s fee of $4,550 per procedure, the billable yearly income for the surgeon is $4,550,000.00. Using a conservative multiplier for hospital billing of 10, the billable income for the hospital is $45,550,000.00. The list could go on about how the hospital and surgeon have combined their efforts to effectively deliver quality medical care while efficiently utilizing resources to maximize revenue.

    As detailed in the book, a system like this did not occur overnight. You cannot just look at a single individual department in the hospital and expect that its maximization would deliver a similar system to the above example. Instead, you must look at every department that the patient would come into contact with either directly or indirectly and make sure to identify any processes which might delay, deter or bottle neck the overall delivery system.

    Hospital and Healthcare Organizations [Management Strategies, Operational Techniques, Tools, Templates and Case Studies] is divided into three sections; 1) managerial fundaments, 2) policy and procedures and 3) strategies and executions. From these essential topics comes direction and guidance through the use and application of practical health care centered discussion, templates, checklists and clinical examples to provide the framework for building a clinically efficient system.

    The health care delivery system is not an assembly line but with persistence and time following established guidelines established in this book, quality patient care can be delivered, efficiently, affordably while maintaining financial viability of institutions and practices.

    James Winston Phillips MD MBA JD LLM
    Post Office Box #600284
    Saint Johns, FL 32260-0284
    Ph: (904) 613-3062


  2. Changing incentives in the operating room

    Last year Nicholas Fogelson MD wrote about a few strategies for decreasing costs in the operating room.

    Since beginng in his fellowship, and operating many days per week, he has come up with a new idea, this time a bit more radical.


    Of course, this new book will help doctors, clinics, hospitals and ASCs more pragmatically.

    Dr. David Edward Marcinko MBA


  3. Don’t always blame anesthesia for problems in the OR

    People blame anesthesia personnel for everything. You name it, they blame the gassers for it. They call them by the umbrella name “Anesthesia” and if there’s a problem, it’s always “Anesthesia’s” fault.

    Got into the operating room late? Blame Anesthesia (Even though the anesthetist’s been sitting at the bedside for twenty minutes waiting for the surgeon or the nurses to be ready.) Patient craving ice cream when she woke up? Must be Anesthesia’s fault!


    True or not?

    Dr. David Edward Marcinko MBA CMP™


  4. Using OR efficiency to improve customer and staff satisfaction

    In today’s fast-paced, cutting-edge healthcare climate, hospitals must provide an operating room environment that meets the demands of the surgeons and customers, while at the same time providing excellent care and outcomes.

    Here is one community-based surgical hospital has successfully met this challenge through efficiency strategies and solutions.


    Any thoughts on this follow-up to the above original ME-P?

    Ann Miller RN MHA


  5. And now ER best practices improve flow-thru

    With half (46 percent) of healthcare leaders saying their emergency department (ED) is overcrowded, hospitals in emergency care are setting their sights on improving patient flow, HealthLeaders Media just reported.


    Hope Rachel Hetico RN MHA


  6. 10 Questions for Optimizing Patient Flow in Your Organization

    Optimizing patient flow in your healthcare organization is crucial to your team’s efforts to deliver top-quality care in an efficient manner.

    Enjoy this essay by Yolanda Otero Inman RN, MSN.




  7. Seven [7] ways lean healthcare management reduces cost

    With the financial pressures that healthcare organizations are facing, many hospitals are using traditional cost cutting methods to save money by looking at layoffs and staff reductions.


    Many more hospitals, however, are finding ways to reduce costs through lean management methods that don’t require layoffs and can improve quality for patients.

    Ann Miller RN MHA


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