Skip to main content

Last Updated October 21, 2024

The Problem: Long Case Times Drive Down OR Volume

Many hospital leaders understand the problem of inefficient turnover in the OR. Long gaps between cases lead to low utilization and weak revenue. Few leaders, however, pay attention to a closely related issue — long average case times.

How long should surgery take? That depends on the procedure, the patient and other factors. Within any hospital OR, however, there is usually a wide variation in average operative time between the most efficient and the least efficient surgeons. This variation is not connected to quality. Studies have linked extended case time to poorer patient outcomes.

Why surgical case time matters

Long average case time is not just an OR issue — it is a hospital leadership issue. Case time inefficiency can have a negative effect on hospital economics.

Compare two hospital surgery departments (see table at bottom). Each department runs 8 rooms and has an average contribution margin per procedure of $6,500. Hospital B’s average case time is 10% less than Hospital A’s. This allows Hospital B to accommodate 7% more cases with the same resources.

The bottom line is that a relatively small difference in average case time can add or subtract millions of dollars in surgical services revenue. Unfortunately, many hospital ORs find themselves on the losing side of this scenario.

How do you get from typical inefficiency to exceptional performance? The first step is to understand the root causes of long surgical case times.

8 Factors That Drive Case Time Inefficiency

8 Factors That Drive Case

  1. Staff are putting out last-minute fires. In many ORs, staff members are constantly scrambling to find missing labs and verify medical clearance. If a patient has already entered the OR, these issues add time to the case.
  2. The team moves forward one step at a time. OR processes often proceed sequentially when they could take place simultaneously. For example, staff may clean the room, then set up the instrument table, and then bring in the patient.
  3. Incorrect preference cards create confusion. The supplies required for each procedure are specified on the surgeon preference card. When preference cards are inaccurate, supply set-up takes extra time.
  4. Anesthesia uses the OR as a procedure room. In many hospitals, anesthesia providers place central lines, do epidurals and perform other procedures in the operating room. This takes up time in the hospital’s most expensive setting.
  5. Work slows down when the surgeon is out. Many surgeons arrive at the OR in time for incision and leave immediately after close. However, time studies have shown that when the surgeon is absent, OR staff members slow down significantly.
  6. Late surgeon arrival creates rework. Observation has shown that surgeons who arrive after patient prep often request changes in set-up and patient positioning. This avoidable rework extends case preparation.
  7. The surgeon didn’t plan ahead. Efficient surgeons develop a surgical plan before every procedure. But some surgeons may not even look at films until they are in the surgical suite. This takes up valuable OR time and increases the risk of unanticipated problems.
  8. The surgery is done, but the patient can’t leave. If the PACU is full, patients may need to wait in the OR after their procedure is complete. Oftentimes the PACU is backed up because of inpatient bed constraints. Either way, post-op bottlenecks add expensive minutes to case time.

“In many ORs, staff are constantly scrambling to find missing labs and verify medical clearance.”

Measuring Case Time

Many hospitals measure surgical case time from incision to closure. However, defining case time as “cut to close” makes it impossible to track all the factors that create wasted time in the OR. The appropriate definition of case time is “wheels in to wheels out.” This metric pro-vides a comprehensive measure of OR case time efficiency.

Negative Effects Spread Across the Organization

We know that case time inefficiency suppresses case volumes and OR revenue. It also increases labor costs relative to production, resulting in low OR profitability. This is bad news for the organization overall, since most hospitals depend on surgical services to deliver the bulk of revenue and margin.

Long case times also have a negative effect on the internal dynamics of the OR. It’s important to understand that surgeons do not control all of the factors that lead to long case times. Many surgeons are frustrated by their inability to be more productive in the OR. Surgeons often end up transferring their volume to more efficient ORs where a day of surgery can generate more income.

The good news is that these problems are not irreversible. Many hospitals have improved OR operational efficiency and financial outcomes by reengineering perioperative processes. Recently, an orthopedic specialty hospital in New York City accomplished a dramatic performance turnaround by addressing the root causes of case time inefficiency.

Author

  • Surgical Directions

    Surgical Directions is the nation’s premier clinician-driven perioperative consulting, technology, and workforce solutions organization. We have an unmatched depth of knowledge in the procedural space, with solutions that have been perfected over 25 years and across more than 500 healthcare clients.

    View all posts

At Surgical Directions, We Offer a Variety of Perioperative Optimization Services.

Surgical Directions

Surgical Directions is the nation’s premier clinician-driven perioperative consulting, technology, and workforce solutions organization. We have an unmatched depth of knowledge in the procedural space, with solutions that have been perfected over 25 years and across more than 500 healthcare clients.