Analysis of operating room efficiency between a hospital-owned ambulatory surgical center and hospital outpatient department☆
Introduction
Developments in surgical care and technology have provided an opportunity to perform a variety of outpatient operations. Procedures such as laparoscopic cholecystectomy are now considered safe in the outpatient setting.1 These and other commonly performed general surgery operations are typically performed in ambulatory surgery centers (ASCs) or hospital outpatient departments (HOPs).2 ASCs, which have been referred to as “focused factories,” are appealing to surgeons as they potentially provide an opportunity to achieve maximum productivity that may not be achieved in HOPs.3
Despite the perceived increase in productivity gained from performing operations at ASCs, there is a paucity of data comparing them to their HOP counterparts, especially when both units are owned by the same hospital system. When comparing freestanding ASCs to hospital-based surgical centers, perioperative times at the ASCs have been shown to be significantly shorter,4 which may lead to an increase in the number of cases that can be performed in a standard workday.
In our hospital system, outpatient general surgery procedures are performed at our hospital-owned ASC and HOP. Yet even with similar case complexity, operating room (OR) workflow is variable in these facilities. In this study, we aimed to compare OR efficiency between these centers. Specifically, we sought to quantify the various components of an operation from patient arrival to the operating suite to patient exit. We hypothesized that all operative components would be shorter in the ASC than the HOP.
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Methods
A retrospective review of all adult outpatient general surgical procedures from May 2017–December 2017 was performed. Institutional review board approval was obtained. The primary inclusion criterion was all outpatient operations performed using general anesthesia by eleven surgeons at our ASC and HOP. Operations that required admission after elective surgery, or those done under local, regional, or monitored anesthesia care were excluded. The total number of patients excluded from the study
Results
Overall, 220 procedures were performed (114 ASC, 106 HOP). When comparing OR efficiency (in minutes) between the two centers, the mean HOP ancillary time was longer than the ASC (32.2 ± 7.0 vs. 22.2 ± 4.5; p < 0.01). In addition, procedure time (77.4 ± 44.9 vs. 56.2 ± 23.0 p < 0.01), exit time (11.8 ± 4.4 vs. 8.5 ± 4.3; p < 0.01), turnover time (29.8 ± 9.6 vs. 24.5 ± 12.7; p < 0.01), and nonoperative time (62.9 ± 21.9 vs. 48.7 ± 15.0; p < 0.01) were longer at the HOP than the ASC (Table 2). The
Discussion
In our current study, we demonstrate that outpatient operations at our HOP have a longer mean ancillary time, exit time, turnover time, and higher nonoperative time when compared to the ASC. These results suggest that outpatient operations are more efficiently performed at a dedicated surgery center such as an ASC. This trend was also present when evaluating our most commonly performed operations individually (Table 4). Moreover, we have identified that attending surgeon delays to the OR
Conclusion
ASC outpatient procedures are more efficient than those performed at the HOP, specifically with regards to nonoperative time. Attending surgeon delays may be one contributing factor to the increased nonoperative time observed at the HOP compared to the ASC. This data suggests the need for a system evaluation in our hospital system to further improve OR efficiency.
Disclosure
The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.
Acknowledgments
The authors would like to thank Dave Primm for help in editing this article.
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Meetings submitted to: This original work was presented as a quickshot presentation at the 2018 Annual Congress of the American College of Surgeons and has not been submitted or published elsewhere.