Deliberate perioperative systems design improves operating room throughput
Deliberate perioperative systems design improves operating room throughput
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DOI：
10.1097/00000542-200508000-00025
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发表时间：
2005-08-01
期刊：
影响因子：
8.8
通讯作者：
Rattner, D
中科院分区：
文献类型：
--
作者：
Sandberg, WS;Daily, B;Rattner, D
背景：新的手术室 (OR) 设计更多地关注手术环境而不是护理过程。作者试图通过对演示手术室及其内部和周围发生的围手术期的目标导向设计来提高手术室吞吐量并减少每个病例的时间。方法：作者建造了一个三室套房，包括手术室、诱导室和早期恢复区。传统上，顺序活动是并行进行的，非手术活动从手术室转移到支持空间。新的工作流程得到了额外麻醉和护理人员的支持。作者使用回顾性、病例和外科医生匹配的设计来比较新手术室与传统手术室的吞吐量、成本和收入绩效。结果：对于在两种环境中执行相同病例组合的外科医生来说，新手术室每天比传统手术室处理更多的病例，并且每个病例使用的时间更少。吞吐量的提高来自于卓越的非操作性能。新手术室的非手术时间从 67 分钟（95% 置信区间，64-70 分钟）减少到 38 分钟（95% 置信区间，35-40 分钟）。非手术时间的所有组成部分均显着减少。手术时间减少约 5%。每个病例的医院和麻醉成本有所增加，但增加的吞吐量抵消了成本，并且全球净利润保持不变。结论：精心设计的手术室和围手术期流程重新设计提高了吞吐量。绩效改进源自重新定位和重组非经营性活动。更好的手术室吞吐量会带来额外的成本，但允许更多的患者入住手术室，同时产生平衡这些额外成本的收入。
Background: New operating room (OR) design focuses more on the surgical environment than on the process of care. The authors sought to improve OR throughput and reduce time per case by goal-directed design of a demonstration OR and the perioperative processes occurring within and around it.Methods: The authors constructed a three-room suite including an OR, an induction room, and an early recovery area. Traditionally sequential activities were run in parallel, and nonsurgical activities were moved from the OR to the supporting spaces. The new workflow was supported by additional anesthesia and nursing personnel. The authors used a retrospective, case- and surgeon-matched design to compare the throughput, cost, and revenue performance of the new OR to traditional ORs.Results: For surgeons performing the same case mix in both environments, the new OR processed more cases per day than traditional ORs and used less time per case. Throughput improvement came from superior nonoperative performance. Nonoperative Time was reduced from 67 min (95% confidence interval, 64-70 min) to 38 min (95% confidence interval, 35-40 min) in the new OR. All components of Nonoperative Time were meaningfully reduced. Operative Time decreased by approximately 5%. Hospital and anesthesia costs per case increased, but the increased throughput offset costs and the global net margin was unchanged.Conclusions: Deliberate OR and perioperative process redesign improved throughput. Performance improvement derived from relocating and reorganizing nonoperative activities. Better OR throughput entailed additional costs but allowed additional patients to be accommodated in the OR while generating revenue that balanced these additional costs.