Background: Operating rooms (ORs) are major source of both hospitals’ revenue and expenses; hence, OR efficiency is not only essential, but challenging for providing high-quality care, whilst utilizing limited resources.

Materials and Methods: A prospective, observational study was conducted in a tertiary care university hospital to identify both causes and effects of inefficient OR flow, including the rate of first case tardiness, time delays while patients are in room, turnover time, cancellation rate, and OR-overutilization. Patients scheduled for elective surgery between September 2014 and February 2015 were recruited.

Results: Three thousand nine hundred sixty-five elective surgical cases were recruited. The rate of first case tardiness was 48%. The average delay time of the first case was 25±16.6 minutes, with the main cause being late arrivals of surgical teams (97.4%). The rate of time delay while the patients were in room, was 73.2%. This is being associated with both the surgical and the anesthesia teams (83%), as well as positioning and procedures-related to the general anesthesia. The delay in turnover time was 12.9% with an average of 32.3±23.3 minutes, with most common causes being swapping of cases between ORs (22.7%) and delays in transferring patients from the ward (21.7%). The cancellation rate was 11.8%, with General surgery having the highest rate (15.5%) due to insufficient OR time (26.2%). Sixty-four-point-eight percent of the operations continued after working hours, with an average of 121.7±106.1 minutes (range 4 to 670 minutes).

Conclusion: The present study identified five process points of OR inefficiency in a university hospital, demonstrating that there are substantial opportunities for enhancement of OR efficiency.

Keywords: Efficiency, Operating room, First case, Tardiness, Cancellation, Turnover time, Utilization

DOI: doi.org/10.35755/jmedassocthai.2020.09.9953

Received 22 May 2019 | Revised 10 June 2019 | Accepted 12 June 2019