Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022 Nov 8;65(6):E739-E748.
doi: 10.1503/cjs.004021. Print 2022 Nov-Dec.

Evaluation of a tiered operating room strategy at an academic centre: comparing high-efficiency and conventional operating rooms

Moaz Chohan  1 , Aurelia Bihari  2 , Christina Tieszer  1 , Melanie MacNevin  1 , Cheryl Churcher  1 , Cathy Vandersluis  1 , Florence Cassar  1 , Cheng Lin  1 , Emil Schemitsch  1 , David Sanders  1 , Abdel-Rahman Lawendy  1
Affiliations
Randomized Controlled Trial

Evaluation of a tiered operating room strategy at an academic centre: comparing high-efficiency and conventional operating rooms

Moaz Chohan et al. Can J Surg. .

Abstract
in English, French

Background: Wait times for many elective orthopedic surgical procedures in Ontario have become unacceptably long and substantially exceed the recommended guidelines. As a consequence, many patients experience chronic pain, disability and other poor health outcomes. The purpose of this study was to test a novel, resource-saving redesign of outpatient operating room (OR) services, based on tiered grouping of surgical cases, to maximize health benefits for patients while improving efficiency and decreasing wait times.

Methods: This prospective cohort study enrolled adult patients scheduled to undergo unilateral lower limb procedures that had a low requirement for surgical resources and did not require admission to the hospital (ambulatory surgical services) at an academic hospital. Patients were randomly assigned to a conventional OR group or a high-efficiency (tiered) OR group, in which the intensity of surgical, anesthesia and nursing resources was matched to the procedure and the patient's health status. The tiered OR made use of local anesthesia and a block room rather than general anesthesia. Primary outcomes were costs of surgical services provided and patient health outcomes; secondary outcomes were patient and staff satisfaction with each OR setup.

Results: The costs associated with the high-efficiency OR were 60% lower than those associated with the conventional OR (this was primarily due to the streamlining of OR care and elimination of the need to use a postanesthetic care unit), with the same or equivalent patient health outcomes. No differences in patient and staff satisfaction were found between the 2 setups.

Conclusion: The use of tiered, ambulatory services for elective orthopedic surgery does not compromise health outcomes and patient satisfaction, and it is associated with substantial cost savings.

Contexte:: En Ontario, les temps d’attentes de plusieurs interventions en chirurgie orthopédique non urgentes s’allongent déraisonnablement et excèdent largement ceux des lignes directrices. Par conséquent, plusieurs patients doivent vivre avec de la douleur chronique, une invalidité ou d’autres problèmes de santé. Le but de cette étude était de mettre à l’essai une nouvelle configuration des services en salle d’opération pour les patients ambulatoires qui permettrait d’économiser les ressources et qui se fonderait sur un regroupement des cas chirurgicaux en échelons afin de maximiser les bienfaits pour la santé des patients tout en améliorant l’efficacité et en diminuant les temps d’attente.

Méthodes:: Dans cette étude de cohorte prospective, les patients adultes participants ont subi dans un hôpital universitaire une intervention chirurgicale unilatérale à un membre inférieur demandant peu de ressources et ne nécessitant pas d’hospitalisation (services de chirurgie ambulatoire). Les patients étaient répartis aléatoirement en 2 groupes : 1 groupe était assigné à une salle d’opération classique, et l’autre à une salle à rendement élevé (interventions échelonnées), où l’intensité des ressources allouées à l’intervention, à l’anesthésie et au personnel infirmier correspondait au type d’intervention et à l’état de santé du patient. La salle d’opération par échelons avait la possibilité d’utiliser l’anesthésie locale dans une salle d’anesthésie locorégionale plutôt qu’une anesthésie générale. Les paramètres principaux de l’étude étaient le coût des services chirurgicaux fournis et les résultats cliniques des patients; le paramètre secondaire était la satisfaction des patients et du personnel de chaque configuration de la salle d’opération.

Résultats:: Les coûts associés aux salles d’opération à rendement élevé étaient inférieurs de 60 % à ceux associés aux salles d’opération classiques (cette différence s’expliquerait par la simplification des soins en salle d’opération et l’élimination du besoin d’une salle de réveil), pour des résultats cliniques similaires ou équivalents. Aucune différence dans la satisfaction des patients et du personnel n’a été observée entre les 2 configurations.

Conclusion:: Le recours à l’échelonnage des services ambulatoires pour l’exécution des interventions en chirurgie orthopédique non urgentes ne compromet ni les résultats cliniques ni la satisfaction des patients et s’accompagne d’une réduction substantielle des coûts.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Fig. 1
Fig. 1
Case turnover times in the high-efficiency and conventional operating room (OR). LHSC = London Health Sciences Centre.
Fig. 2
Fig. 2
Patient health outcomes as measured by the Patient-reported Outcomes Measurement Information System (PROMIS): (A) pain interference; and (B) global (mental and physical health) scores. T-scores were compared with those of the general North American population. In the box-and-whisker plots, the box represents the median and interquartile range; the whiskers represent the most extreme values within 1.5 times of the interquartile range beyond the 25th and 75th percentile. OR = operating room.
Fig. 3
Fig. 3
Patient health outcomes as measured by EQ-5D-5L: (A) visual analogue scale (VAS) score of overall health, (B) index value and (C) quality-adjusted life years. In the box-and-whisker plots, the box represents the median and interquartile range; the whiskers represent the most extreme values within 1.5 times of the interquartile range beyond the 25th and 75th percentile.
Fig. 4
Fig. 4
Education level (A) and experience with previous surgical procedures (B) of patients in the conventional and high-efficiency operating room (OR) groups. GED = General Educational Development certificate; HS = high school.
See this image and copyright information in PMC

References

    1. National health expenditure trends, 1975 to 2019. Ottawa: Canadian Institute for Health Information; 2020.
    1. Measuring wait times for orthopedic surgeries. Toronto: Health Quality Ontario. Available: www.hqontario.ca/System-Performance/Measuring-System-Performance/Measuri... (accessed 2021 Jan. 13).
    1. Ackerman IN, Bennell KL, Osborne RH. Decline in health-related quality of life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study. BMC Musculoskelet Disord 2011;12:108. - PMC - PubMed
    1. Desmeules F, Dionne CE, Belzile ÉL, et al. . The impacts of pre-surgery wait for total knee replacement on pain, function and health-related quality of life six months after surgery. J Eval Clin Pract 2012;18:111–20. - PubMed
    1. Health Measures. PROMIS (Patient-Reported Outcomes Measurement Information System). Evanston (IL): Northwestern University. Available: www.healthmeasures.net/explore-measurement-systems/promis (accessed 2018 Oct. 26).

Publication types