Capacity problems in the OR

OR capacity

Filling out the maximum possible capacity should be the overall aim of all stakeholders from managment to patient caregivers. Unfortunately this is not working smoothly at our institution for several problems. Although a professional and independent OR managament has been instituionalized, capacity is still ufulfilled. This is mainly due to the fact that  changeover times are too long and in particular well trained OR nursing staff is missing with many open positions and difficulties to recruit staff.


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Participant comments on Capacity problems in the OR

  1. You can’t have efficient OR’s if they are not fully staffed. What are the reasons that there are so many open positions and why is it difficult to retain staff?

  2. Isabelle,

    I echo what Joe has said. More information needs to be included:

    1.) Staffing- Levels and Retention
    2.) Why are changeover times so elongated- Surgeon/Staffing/Anesthesia
    3.) Are cancellation/late starts being managed

  3. I would create dedicated OR’s for the planneble care, so that at least a portion of your surgery is very efficiently organised

  4. We have a standing “Operating Room Committee” composed of physicians, nurses, and administrators that sets rules, priorities and metrics. The consensus decision process incorporates the stakeholders and the execution team.

  5. I would be interested in hearing more on that “OR Committee”. How can a physician, nurse, administrators team work efficiently? Isn’t this always ending in a weak compromise? How many people sit in such a committee?

  6. Our committee consists of a chair (MD), departmental administrator, 4 MD surgeons, practice administrator, OR director (RN), OR scheduling administrative assistant, one MD anesthesiologist (1), one resident physician (MD), and QA representative. The operating room consists of 3 rooms, running about 4300 cases per year.

    The committee is tasked with creating policy (e.g. OR start time, block time), determining metrics to follow (e.g. turnaround time, complications, utilization), and advising on capital spending (new equipment). We encourage frank, collegial discussion and egos are left at the door. The process began with the basics, developing goals for the committee, agendas for meetings, reporting, and so on. It took about 3 meetings before we were satisfied with the organizational structure and it has been successful in improving OR performance and patient and surgeon satisfaction. It remains a work in progress, though.

  7. By “changeover times are too long” I assume you are referring to turn-over time between cases? I had the opportunity to be part of very efficient OR that the turn-over is less than 10 min. The efficiency of OR depends on anesthesia (i.e. blocks or spinal anesthesia are performed prior to OR), nursing (minimum 2 circulatory and 2 scrub techs in joint cases) and surgeons (standardizing procedures and maximizing proficiency). The personal have to be incentivized to be paid based on volume, not time. This way more cases will get done.

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