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Health Care Manag Sci (2009) 12:142146 DOI 10.1007/s10729-008-9073-8
What is the best workflow for an operating room? A simulation study of five scenarios
Riitta A. Marjamaa & Paulus M. Torkki &
Eero J. Hirvensalo & Olli A. Kirvel
Received: 25 October 2007 /Accepted: 17 June 2008 /Published online: 26 July 2008 # Springer Science + Business Media, LLC 2008
Abstract Parallel induction of anesthesia improves operating room (OR) efficiency. To support decision-making as to optimal facilities and optimal use of resources, we compared the cost-efficiency of several workflow models of parallel induction to that of the traditional model, using discrete-event simulation. For each scenario, average number of procedures performed, surgery time, daily over- and under-utilized time, and staffing costs per operation were assessed. We also studied whether scheduling short and long procedures in separate rooms would amplify the effects of the parallel processing. All parallel work-flow models demonstrated better cost-efficiency than the traditionally sequenced working pattern. Staffing costs per procedure were 7% lower in the
best induction model than in the traditional model. When short procedures were scheduled separately, differences between induction models were small.
Keywords Parallel processing . OR management . Efficiency. Workflow. Operating room . Simulation
Parallel processing, mainly concurrent induction of anesthesia, seems to improve operating room (OR) efficiency [13]. Several approaches for parallel induction have been suggested: Block rooms for epidurals [4] or brachial blocks [5] before surgery; induction rooms with additional personnel to provide anesthesia inductions for one [2, 3] or several operating rooms [1]; surgeons administering local anesthetics in the holding room while the OR is prepared for surgery [6]. All these models have reduced the non-operative time enough to enable more operations to be performed per day.
Hospital facilities, however, are not always suitable for parallel induction. Administrators redesigning or planning new facilities face the dilemma whether it is necessary to add an induction room to every individual OR, or whether a multiple-bed induction room could serve several ORs with fewer personnel. Even in countries where OR facilities are traditionally designed with dedicated induction rooms [7, 8], they may not always be in optimal use.
To support decision-making as to optimal facilities and resource use, we investigated several workflow models of parallel induction by means of computer...