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Operating room management

Operating room management encompasses the strategic, tactical, and operational planning and coordination required to optimize the use of surgical facilities, ensuring efficient resource allocation, patient safety, and high-quality care delivery in healthcare institutions.^[1] This multidisciplinary field integrates clinical, administrative, and logistical elements to address the complexities of perioperative processes, from preoperative preparation to postoperative recovery.^[2] Often led by anesthesiologists serving as medical directors, operating room management focuses on balancing surgeon schedules, staff availability, and equipment needs to maximize throughput while minimizing costs and delays.^[1] Key aspects of operating room management include scheduling at multiple levels: strategic decisions for long-term capacity expansion, tactical planning for annual block time allocations based on surgeon utilization and contribution margins, and operational adjustments for daily case sequencing and add-on procedures.^[1] Resource allocation covers personnel (surgeons, nurses, anesthesiologists), equipment sterilization and maintenance, and material supplies, all aimed at reducing turnover times and overutilized operating room hours.^[2] Efficiency is enhanced through data-driven tools such as algorithms and artificial intelligence for predictive scheduling, which help mitigate bottlenecks like prolonged operative times or resident training impacts.^[3] The importance of effective operating room management lies in its direct influence on surgical performance, patient outcomes, and institutional economics, as poor organization can lead to increased morbidity, extended wait times, and substantial financial losses.^[3] Stable, specialized teams and strong interdisciplinary communication are critical for safety, reducing errors and complications in high-stakes environments.^[3] Amid rising healthcare demands, modern approaches emphasize evidence-based practices, including non-technical skills training and disturbance minimization, to support sustainable operations and equitable access to care.^[3]

Introduction

Definition and scope

Operating room management encompasses the coordination of personnel, equipment, and processes to optimize surgical efficiency, safety, and patient outcomes within hospital or ambulatory surgical settings.^[4] This discipline focuses on the operational aspects of surgical suites, ensuring that resources are allocated effectively to support the delivery of high-quality care while minimizing disruptions in a high-stakes environment.^[5] At its core, it involves real-time decision-making and adaptive strategies to handle the complexities of surgical workflows, drawing on multidisciplinary collaboration among surgeons, anesthesiologists, nurses, and support staff.^[4] The primary objectives of operating room management include maximizing throughput, minimizing delays, ensuring optimal resource utilization, and maintaining sterility protocols to prevent infections.^[6] Throughput refers to the number of surgical cases completed per unit of time, such as cases per day, which serves as a key indicator of overall productivity and capacity.^[6] Minimizing delays, particularly through reduced turnover time—the interval from when one patient exits the operating room (wheels out) to when the next enters (wheels in)—directly contributes to higher efficiency and cost savings.^[7] Resource utilization involves balancing human and material assets to avoid bottlenecks, while sterility maintenance upholds patient safety standards amid constant activity.^[4] The scope of operating room management primarily covers both elective surgeries, which are scheduled in advance, and emergency procedures, which require rapid accommodation often at the expense of planned slots.^[8] It delineates the boundaries of perioperative operations, excluding broader hospital administration functions such as billing, long-term patient care planning, or non-surgical departmental oversight.^[5] A central concept within this scope is block time allocation, which designates reserved time slots in the operating room schedule for specific surgeons or surgical teams to facilitate predictable planning and reduce conflicts.^[9] This approach integrates with hospital workflows to enhance overall surgical delivery without extending into ancillary services.^[4]

Historical development

The foundations of operating room (OR) management trace back to the mid-19th century, when British surgeon Joseph Lister introduced antiseptic techniques in the 1860s, revolutionizing surgical practices by drastically reducing postoperative infection rates through the use of carbolic acid sprays and sterile dressings.^[10] This shift from informal, infection-prone setups—often conducted in makeshift hospital wards or even patients' homes—to more controlled environments laid the groundwork for dedicated surgical spaces. By emphasizing hygiene and systematic preparation, Lister's methods influenced the professionalization of surgery and set the stage for subsequent OR developments.^[11] In the early 20th century, particularly following World War I, experiences with mobile surgical units during the war highlighted the need for standardized hygiene practices, contributing to improvements in operating room facilities, including better infection control measures.^[12] These changes were driven by rising demands for surgical care and the adoption of protective gear like gloves, masks, and gowns, which became routine after 1918, particularly in response to the Spanish flu pandemic, to minimize cross-contamination.^[13] The mid-20th century marked the emergence of formalized OR protocols in the 1950s and 1960s, spurred by exponential growth in surgical volumes—such as the expansion of cardiovascular and orthopedic procedures—and breakthroughs in anesthesia, including the routine use of mechanical ventilators and safer inhalational agents like halothane. Anesthesiologists began advocating for equipment standardization during this era, which extended to procedural guidelines that minimized variability and enhanced patient safety.^[14] These advancements supported the scaling of hospital-based surgery amid postwar healthcare expansion.^[15] During the late 20th century, OR management incorporated computer-aided scheduling in the 1980s and 1990s to address escalating healthcare costs and operational inefficiencies, with early systems enabling algorithmic optimization of case sequencing and resource allocation.^[16] This technological shift was complemented by regulatory frameworks, such as the Joint Commission on Accreditation of Hospitals (JCAHO) standards, which were established in 1951 but evolved significantly in the 1970s—from minimal requirements to performance-based metrics emphasizing quality and risk reduction in OR environments, including infection control standards added in 1976.^[17] Entering the 21st century, lean management principles gained traction in ORs from the early 2000s, focusing on waste elimination and process streamlining through evidence-based practices like data-driven workflow audits.^[18] The COVID-19 pandemic in 2020 accelerated adaptive protocols, including enhanced aerosol mitigation, phased elective surgery resumption, and flexible staffing models to balance emergency and routine care.^[19] Post-2020, OR management has increasingly integrated artificial intelligence for predictive scheduling and resource optimization, further enhancing efficiency as of 2025.^[3]

Facility and Resources

Physical layout and design

The physical layout of operating rooms (ORs) is designed to optimize workflow, maintain sterility, and ensure patient safety during surgical procedures. Standard layouts typically feature a central core OR adjacent to recovery areas, preoperative holding zones, and postoperative care spaces to facilitate seamless patient transfer. This configuration includes zoning into unrestricted areas (e.g., public corridors), semi-restricted areas (e.g., storage and changing rooms), and restricted areas (e.g., the OR itself and sterile core), which helps control access and minimize contamination risks. Traffic flow patterns are engineered to direct movement unidirectionally where possible, separating clean and dirty paths to reduce airborne particulate exposure and cross-contamination.^[20] Key design principles emphasize environmental controls for infection prevention and operational efficiency. Heating, ventilation, and air conditioning (HVAC) systems maintain positive pressure differentials of at least 0.01 inches of water gauge relative to adjacent spaces, with a minimum of 20 total air changes per hour, including at least four changes from outdoor air, to ensure laminar airflow over the surgical site and filter out contaminants. Lighting systems provide high-intensity illumination, with surgical field standards requiring 40,000 to 160,000 lux to enable precise visualization, while general room lighting is adjustable to 500–1,000 lux for non-procedural tasks. Modular wall systems and prefabricated components allow for reconfiguration to accommodate evolving surgical needs, such as integrating advanced imaging equipment.^[21]^[22] Typical OR size and capacity are standardized to support 4–6 personnel comfortably during procedures. New hospital ORs require a minimum clear floor area of 400 square feet for standard rooms, increasing to 600 square feet for image-guided or hybrid ORs with at least one dimension of 20 feet, providing 5 feet of clearance on the patient transfer side and space for equipment booms and carts. Hybrid ORs, which integrate fixed imaging modalities like fluoroscopy or CT scanners, demand larger footprints to accommodate both surgical and radiological workflows without compromising sterility or mobility.^[23] Compliance with regulatory standards from the Facility Guidelines Institute (FGI) ensures these designs meet minimum clearances, accessibility, and surface requirements, such as seamless, coved flooring and washable walls to facilitate cleaning and reduce microbial harboring. FGI guidelines also mandate a functional program assessment to tailor layouts to specific hospital needs, including provisions for accessibility under the Americans with Disabilities Act. These standards integrate with equipment placement to support efficient operations, as detailed in related management protocols.^[23]^[24]

Equipment and supply management

Effective equipment and supply management in operating rooms (ORs) is essential for ensuring the availability, sterility, and functionality of surgical tools and consumables, directly impacting procedural efficiency and patient safety. This involves systematic procurement, inventory control, and maintenance practices tailored to the high-stakes environment of surgical settings, where delays or failures can lead to significant risks. Hospitals typically adopt integrated approaches that balance cost, reliability, and regulatory compliance, often guided by standards from organizations like the Association of periOperative Registered Nurses (AORN). Procurement strategies in OR management prioritize cost-benefit analyses to decide between reusable and single-use items, factoring in lifecycle costs such as initial purchase, maintenance, sterilization, and disposal, as well as risks of obsolescence due to technological advancements. For instance, reusable instruments like forceps may offer long-term savings through durability but require robust reprocessing infrastructure, while single-use devices such as certain catheters reduce infection risks at a higher per-unit cost. Lifecycle cost modeling for procurement can help reduce overall expenses by optimizing the mix of reusable and disposable supplies. Standardization of equipment procurement, such as selecting compatible brands for monitors and endoscopes, further minimizes errors and training needs, with evidence indicating reductions in setup times. Inventory systems for OR supplies employ models like just-in-time (JIT) stocking, which minimizes storage needs by ordering based on real-time demand forecasts, versus par-level models that maintain fixed stock thresholds for critical items like implants and sutures to prevent shortages. Tracking technologies such as RFID tags and barcodes enable automated monitoring of high-value disposables, with RFID systems allowing for real-time location and expiration date checks and helping to reduce waste. These systems integrate with electronic health records to align inventory with surgical schedules, ensuring items like prosthetic implants are available without excess capital tied up in storage. Maintenance protocols for OR equipment follow preventive schedules to uphold reliability, including daily visual inspections and functional tests for anesthesia machines to detect issues like gas leaks or ventilator malfunctions, as mandated by the Joint Commission's standards for high-risk devices. Sterilization cycles, such as autoclaving at 121°C for 15-30 minutes under 15-30 psi pressure, are standard for heat-tolerant reusable instruments, ensuring microbial inactivation while preserving functionality; low-temperature alternatives like ethylene oxide are used for heat-sensitive endoscopes. Vendor-managed equipment programs, where manufacturers handle routine servicing for items like surgical lights, help improve uptime, complementing in-house protocols. Key OR equipment includes adjustable surgical tables for patient positioning, overhead LED lights providing 100,000-160,000 lux illumination for precision, and multi-parameter monitors tracking vital signs like blood pressure and oxygen saturation in real-time. Specialized tools such as flexible endoscopes for minimally invasive procedures require meticulous management due to their complexity and cost, often exceeding $50,000 per unit. Standardization across these categories—ensuring uniform interfaces for tables, lights, and monitors—reduces intraoperative errors, with studies reporting decreases in adverse events through such practices. These elements integrate into the broader facility layout by optimizing storage and access points for quick retrieval during procedures.

Human Resources

Staffing models and roles

Operating room (OR) staffing relies on a multidisciplinary team to ensure patient safety and procedural efficiency, with core roles defined by professional standards and responsibilities during surgical procedures. The surgeon serves as the team leader, performing the operation and making critical decisions, typically requiring extensive training including medical school and residency.^[25] The anesthesiologist monitors vital signs, administers anesthesia, and manages pain throughout the surgery, often specializing in areas like cardiac or neurosurgical procedures.^[26] Circulating nurses oversee the non-sterile environment, coordinate supplies, and document the procedure, while scrub nurses maintain the sterile field and assist directly with instruments; both roles require registered nurse licensure.^[25] Surgical technicians, also known as operating room technicians, handle instrument preparation, sterilization, and passing tools to the surgeon during cases, working collaboratively with physicians and nurses to prevent errors like retained surgical items.^[27] Support staff, such as transporters, facilitate patient movement to and from the OR, ensuring seamless workflow.^[26] Staffing models in ORs balance fixed shifts for routine operations with on-call systems for emergencies, aiming to optimize productivity while adhering to safety guidelines. Fixed shift models schedule personnel for predictable hours, whereas on-call arrangements provide coverage for urgent cases, with recommendations to limit on-call to ensure adequate rest, such as no more than 12 consecutive hours of work or 60 hours weekly.^[28] Common ratios include a 1:1 registered nurse-to-patient ratio in operating rooms during procedures, as mandated in some jurisdictions like California, and broader benchmarks of 2.5 staff members per OR room, with a 67%:33% mix of registered nurses to technologists.^[29]^[28] These models incorporate productive hours targets, typically 0.11 to 0.13 hours of staff time per OR minute, adjusted for case complexity.^[30] Team composition emphasizes a multidisciplinary approach, integrating specialists like perfusionists for cardiac surgeries where they operate heart-lung machines to maintain circulation, alongside standard roles to address procedure-specific needs.^[26] Role clarity is critical in these teams, with defined responsibilities—such as the anesthesiologist verifying allergies or nurses managing the sterile field—reducing ambiguity, enhancing accountability, and preventing conflicts through protocols like checklists and communication tools.^[31] Shift patterns in ORs commonly feature 8-hour rotations for standard coverage or 12-hour extended shifts to align with surgical schedules, with examples including three 12-hour days followed by off periods to manage fatigue.^[32] Peak-hour staffing increases personnel during high-volume periods, such as daytime elective cases, while contingencies for absences rely on on-call or standby staff, who receive stipends and premium pay if activated.^[32] Overtime is regulated under the Fair Labor Standards Act (FLSA), capping nonexempt healthcare workers at 40 hours per workweek before time-and-a-half pay, or alternatively using an 8 and 80 system over a fixed 14-day period where overtime applies after 8 hours daily or 80 hours total.^[33]

Training and certification

Operating room (OR) staff, including registered nurses (RNs), perioperative nurses, and anesthesiologists, must undergo rigorous training and certification to ensure competency in high-stakes surgical environments. These requirements emphasize evidence-based practices, patient safety, and adherence to professional standards, with certifications validating specialized knowledge and skills acquired through formal education and clinical experience.^[34]^[35] Mandatory certifications form the foundation of OR personnel qualifications. For perioperative RNs, the Certified Perioperative Nurse (CNOR) credential, administered by the Competency & Credentialing Institute and aligned with Association of periOperative Registered Nurses (AORN) standards, is the only accredited certification assessing intraoperative knowledge and skills; eligibility requires a current RN license, a minimum of two years (2,400 hours) of perioperative clinical practice, and passing a 200-question exam.^[36]^[37] AORN's Perioperative Nursing: Scope and Standards of Practice further delineates RN responsibilities across preoperative, intraoperative, and postoperative phases, mandating certification where applicable to demonstrate proficiency.^[38] For anesthesiologists, board certification through the American Board of Anesthesiology (ABA) is essential, involving three sequential exams—the BASIC (scientific foundations), ADVANCED (clinical sciences), and APPLIED (oral examination)—following completion of an accredited residency program of at least four years.^[39]^[35] Training programs for OR staff begin with structured orientation for new hires to build foundational competencies in protocols and workflows. New perioperative nurses typically complete a 4- to 12-week orientation, often incorporating AORN's Periop 101 core curriculum, which covers OR environment navigation, patient assessment, and safety procedures through didactic sessions, skills labs, and supervised clinical rotations.^[40]^[41] Simulation-based learning is integral for preparing staff to manage emergencies, such as intraoperative crises, using high-fidelity mannequins and scenarios to practice crisis resource management without patient risk; studies demonstrate that such training improves team performance and adherence to protocols during simulated events like anesthesia complications.^[42]^[43] Continuing medical education (CME) or continuing nursing education (CNE) is required annually to maintain expertise, with perioperative nurses often needing 20 to 30 contact hours per year—sourced from AORN-approved programs—while physicians, including anesthesiologists, must complete 125 credits over a 5-year Maintenance of Certification in Anesthesiology (MOCA) cycle (as of 2024), equivalent to about 25 hours annually.^[44]^[45] Specialized training enhances specific technical proficiencies essential to OR operations. Sterile technique workshops, such as AORN's dedicated course, teach principles of asepsis, including gloving, draping, and maintaining sterile fields to prevent surgical site infections, through hands-on modules and competency assessments.^[46] Equipment handling courses for surgical technologists and nurses cover operation of devices like anesthesia machines, electrocautery units, and endoscopes, often integrated into certification programs like those from MedCerts, emphasizing safe setup, troubleshooting, and infection control.^[47] Team-based drills focus on collaborative tools like the World Health Organization (WHO) Surgical Safety Checklist, with implementation training involving multidisciplinary simulations to ensure consistent use during sign-in, time-out, and sign-out phases, reducing errors by up to 30% in adopting facilities.^[48]^[49] Regulatory oversight ensures ongoing compliance and quality through accreditation and recertification mandates. Bodies like AORN provide CNE accreditation for nursing programs, while the Joint Commission accredits healthcare facilities, requiring documented staff training on OR standards, including annual competency evaluations and emergency preparedness.^[50]^[51] Recertification intervals vary: CNOR requires renewal every five years via exam or 500 practice hours plus 75 continuing education units, and ABA certification demands continuous MOCA participation with reassessment every 5 years (as of 2024), though some subspecialties recertify every five to six years.^[52]^[53] These mechanisms uphold professional standards and adapt to evolving surgical practices.

Operational Processes

Scheduling and planning

Scheduling and planning in operating room (OR) management involves allocating time slots and resources for surgical cases to optimize efficiency while accommodating variability in procedure durations and patient needs. This process ensures that ORs are used effectively without excessive delays, balancing the demands of elective and urgent surgeries. Key approaches include block scheduling, where fixed time blocks are assigned to specific surgeons or specialties to promote predictability and accommodate preferences, and open access scheduling, which operates on a first-come, first-served basis to allow flexibility for ad hoc cases.^[54]^[55] A hybrid modified block plan combines elements of both, reserving portions of the schedule for dedicated blocks while leaving slots open for urgent procedures. To maximize the number of cases scheduled, optimization algorithms such as mixed integer programming are employed, formulating the problem to maximize the total number of cases subject to constraints on OR availability, surgeon time, and resource limits. For instance, the objective function can be expressed as:

\max \sum_{i} x_i

where x_i is a binary variable indicating whether case i is scheduled (1) or not (0), subject to constraints like \sum_{i \in S} d_i x_i \leq T for surgeon S availability T and case durations d_i. These models draw from operational research techniques applied to OR planning.^[56] Planning factors critically influence scheduling accuracy, including estimates of case durations derived from historical data averages for similar procedures and surgeons, which provide a baseline despite inherent variability. Surgeon preferences, such as preferred ORs, times, or sequencing of cases, are incorporated particularly in block scheduling to enhance compliance and reduce conflicts. Prioritization distinguishes elective cases, often handled via first-in-first-out (FIFO) rules or severity-based scores to ensure equitable access, from urgent cases that preempt elective slots based on clinical need.^[57]^[58]^[59]^[60] Tools for scheduling range from manual calendars, which rely on spreadsheets or paper logs for small-scale operations but are prone to errors, to automated systems that integrate optimization algorithms for real-time adjustments within planning phases. These automated tools often incorporate buffers to account for delays from overruns or turnovers, preventing cascade effects on subsequent cases. Such buffers help maintain flow without overcommitting resources.^[61] Overall, effective scheduling targets OR utilization rates of 80-85%, as higher levels (above 85-90%) increase the risk of delays and overtime without proportional gains in throughput, allowing flexibility for emergencies while integrating with staffing models to align personnel availability.^[62]

Preoperative and intraoperative coordination

Preoperative coordination in the operating room begins with patient verification through the time-out protocol, a standardized pause immediately before incision to confirm patient identity, procedure, site, and consent, involving all team members to prevent wrong-site surgery. This protocol, part of the Universal Protocol, is conducted with the patient in position and after anesthesia induction if applicable, ensuring consensus on critical details. Site marking follows verification, where the surgeon or designee uses an indelible marker to indicate the operative site on the patient's body, visible post-draping, as required for procedures with laterality or multiple sites to enhance accuracy. Anesthesia induction then occurs, typically involving intravenous administration of agents to achieve unconsciousness, securing the airway, and establishing monitoring, often lasting under 5 minutes in a controlled environment to transition the patient safely into surgery. Room setup and turnover, the interval between cases for cleaning and preparation, averages 20-45 minutes depending on procedure complexity, with efficient teams targeting under 30 minutes to maintain schedule adherence. Intraoperative coordination relies on structured communication, such as team briefings at procedure start to outline roles, anticipate needs, and foster a shared mental model, reducing errors through proactive dialogue among surgeons, nurses, and anesthesiologists. Instrument passing is managed by circulating and scrub personnel in a coordinated manner, with nurses anticipating surgeon requests based on procedural phases to ensure sterile efficiency and minimize delays. Vital signs monitoring occurs continuously under general anesthesia, with oxygenation, ventilation, circulation, and temperature assessed at least every 5 minutes to detect deviations promptly. Pauses for surgical counts of sponges, needles, and instruments are performed initially, during reliefs or additions to the field, and before closure, following a consistent sequence from the surgical site outward to prevent retained items, with discrepancies prompting immediate resolution. Handoffs during surgery, such as shift changes or surgeon transitions, utilize the SBAR framework—Situation, Background, Assessment, Recommendation—to standardize information transfer, ensuring continuity by covering patient status, procedural progress, and immediate concerns in a concise, structured format. This approach improves communication accuracy and reduces adverse events in perioperative settings. Effective time management minimizes interruptions through designated no-interruption zones during critical phases, silencing non-essential devices, and limiting traffic to preserve focus and flow. Case durations in general surgery vary, averaging around 2 hours but ranging from 1 to 4 hours based on procedure type and complexity, with reliance on pre-scheduled slots to optimize throughput.

Safety and Quality Control

Infection prevention protocols

Infection prevention protocols in operating rooms focus on minimizing surgical site infections (SSIs) by implementing rigorous sterility measures, environmental controls, and standardized procedures to reduce microbial contamination during surgical procedures. These protocols are essential, as SSIs affect approximately 2-4% of surgical patients in the United States. Globally, rates vary, with a pooled incidence of about 2.5% but reaching up to 11% in low- and middle-income countries.^[63]^[64]^[65] SSIs can lead to prolonged hospital stays and increased mortality. Key elements include behavioral practices by personnel and systemic environmental management to maintain an aseptic field. Sterility measures begin with hand hygiene, following the World Health Organization's (WHO) "5 Moments for Hand Hygiene," which include cleaning hands before touching a patient, before clean/aseptic procedures, after body fluid exposure risk, after touching a patient, and after touching patient surroundings—adapted specifically for perioperative settings to prevent cross-contamination.^[66] Surgical personnel must wear appropriate attire, such as clean scrubs, masks covering the nose and mouth, protective eyewear, and sterile gowns and gloves during procedures, to limit shedding of skin particles and respiratory droplets that could contaminate the surgical site.^[67] No-touch techniques, often implemented via Aseptic Non-Touch Technique (ANTT), ensure that key parts of instruments and sites (e.g., incision areas) are not directly handled by ungloved hands, reducing direct microbial transfer.^[68] Additionally, antimicrobial prophylaxis is administered, with cefazolin typically dosed at 2 g intravenously (3 g for patients ≥120 kg) within 60 minutes prior to incision to achieve adequate tissue concentrations against common pathogens like Staphylococcus aureus.^[69] Environmental controls are critical to maintaining a low-bioburden airspace around the surgical field. Laminar airflow systems direct filtered air downward over the operative site at velocities of 0.3–0.5 m/sec, displacing airborne particles and reducing contamination risk, though evidence on their impact on SSI rates remains mixed.^[70] Surfaces in the operating room, including tables, floors, and equipment, must be disinfected using EPA-registered agents such as quaternary ammonium compounds or hydrogen peroxide-based solutions, applied after each procedure to eliminate residual pathogens.^[71] Air quality is maintained through high-efficiency particulate air (HEPA) filtration to minimize airborne microbial settling, with standards for ultra-clean zones recommending fewer than 100 particles per cubic foot for particles ≥0.5 μm near the surgical field.^[72] Broader protocols encompass universal precautions, which treat all blood and body fluids as potentially infectious, mandating the use of personal protective equipment, safe injection practices, and respiratory hygiene to prevent transmission in the operating room.^[73] Instrument sterilization is validated using biological indicators, such as Geobacillus stearothermophilus spores, which are subjected to the sterilization cycle (e.g., steam or ethylene oxide) and incubated to confirm microbial inactivation, ensuring a sterility assurance level of 10⁻⁶.^[74] Ongoing surveillance tracks SSI rates through systems like the CDC's National Healthcare Safety Network (NHSN), aiming to maintain rates below 2% for common procedures as a benchmark for effective prevention.^[75] In the event of an infection outbreak, response involves immediate contact tracing to identify exposed individuals and sources, coupled with enhanced cleaning protocols using sporicidal agents on all high-touch surfaces and temporary suspension of elective procedures until the source is remediated.^[76] These measures, supported by design features like positive-pressure ventilation, help contain transmission rapidly.^[77]

Risk assessment and emergency response

Risk identification in operating room management employs structured tools like Failure Mode and Effects Analysis (FMEA), a proactive method that assembles multidisciplinary teams to map processes, pinpoint potential failure modes, and evaluate their impacts to prioritize risk mitigation.^[78] In the OR context, FMEA targets scenarios such as power failures disrupting equipment function or wrong-site surgery due to procedural errors, assessing each failure mode's severity (1-10 scale for harm potential), occurrence (1-10 for likelihood), and detectability (1-10 for ease of identification).^[78] The resulting Risk Priority Number (RPN), calculated as severity × occurrence × detectability, guides interventions by focusing on high-RPN items, such as improving backup power systems or enhancing site verification checklists to reduce overall perioperative risks.^[78] Emergency protocols ensure rapid, coordinated responses to acute crises. For cardiac arrest, a code blue activation triggers immediate cardiopulmonary resuscitation (CPR) upon recognition, with standardized teams including anesthesiologists and OR staff mobilizing via alarms and pages to minimize response delays.^[79] In cases of massive intraoperative hemorrhage, protocols initiate massive transfusion—defined as administering 10 or more units of packed red blood cells within 24 hours—anticipating ongoing bleeding to restore volume and achieve hemostasis through balanced blood product delivery.^[80] Fire evacuation plans emphasize containment first, such as disconnecting oxygen sources and smothering flames with saline, followed by horizontal transfer of patients and staff to adjacent safe compartments using predefined routes and portable equipment to avoid vertical movement risks.^[81] Drills and simulations reinforce preparedness through regular mock events, often conducted quarterly, that replicate crises like arrests or evacuations in realistic OR settings with mannequins and actual equipment.^[82] These exercises conclude with debriefings to review performance and foster psychological safety, enabling teams to refine coordination without real patient harm. Post-incident, root cause analysis employs fishbone diagrams (Ishikawa diagrams) to categorize contributing factors—such as human errors, equipment issues, or policy gaps—systematically tracing adverse events back to underlying causes for targeted preventive measures.^[83] Regulatory compliance mandates adherence to Joint Commission Sentinel Event alerts, which highlight serious adverse events like unanticipated OR deaths or permanent harm, requiring organizations to conduct thorough reviews and implement corrective actions to achieve zero preventable errors.^[84] Trained staff, as detailed in certification guidelines, are essential for executing these protocols effectively during high-stakes responses.^[79]

Performance and Technology

Metrics and evaluation

Operating room management relies on a suite of quantitative and qualitative metrics to assess efficiency, safety, and effectiveness, enabling data-driven decisions that optimize resource use, reduce delays, and improve patient care. These metrics encompass operational performance indicators, safety outcomes, financial measures, and patient feedback, often tracked through standardized protocols to ensure comparability across facilities. By focusing on key benchmarks, managers can identify inefficiencies, such as underutilized time or preventable errors, while aligning with broader healthcare quality goals. Key performance indicators (KPIs) for operational efficiency primarily include the operating room (OR) utilization rate, calculated as the percentage of scheduled time occupied by actual surgical cases, with targets typically set at 75-85% to balance productivity and avoid excessive delays.^[85] The on-time start rate, especially for first cases of the day, is another vital KPI, aiming for greater than 85% to enhance throughput and minimize cascading delays.^[86] Complementing these, analysis of delay causes—such as equipment unavailability, staffing shortages, or patient preparation issues—helps pinpoint root factors through root-cause methodologies, informing targeted interventions.^[87] Safety metrics emphasize low rates of adverse events, with wrong-site surgery incidents reported at rates ranging from 0.09 to around 0.5 per 10,000 procedures.^[88]^[89] Patient satisfaction scores, gathered via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, provide qualitative insights into perioperative experiences and correlate positively with objective surgical quality measures.^[90] Financial safety is reflected in cost per case, which ranges from $5,000 to $20,000 depending on procedure type and complexity, serving as a proxy for resource control and error prevention.^[91] Evaluation methods include benchmarking against national databases like the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which offers risk-adjusted data on surgical outcomes for inter-facility comparisons.^[92] Internal audits, conducted periodically to review compliance and performance, combined with real-time dashboards for metric visualization, enable proactive oversight. Software tools may assist in aggregating this data for analysis, though interpretation remains central to management practices. Improvement cycles such as the Plan-Do-Check-Act (PDCA) framework drive iterative enhancements by planning data-informed strategies, executing changes in OR workflows, checking outcomes against established metrics, and acting to standardize successful adjustments.^[93] This cyclical approach has been shown to reduce infection rates and optimize nursing quality in surgical settings when applied systematically.^[94]

Software and digital tools

Software and digital tools play a crucial role in automating and optimizing operating room (OR) management, enabling real-time decision-making and integration across perioperative workflows. These systems encompass scheduling platforms, inventory trackers, and intraoperative aids that enhance efficiency while reducing errors. By leveraging data analytics and connectivity standards, they support seamless coordination among staff, equipment, and patient records. Scheduling software, such as Epic OpTime and Cerner's SurgiNet, facilitates real-time booking and resource allocation in the OR. Epic OpTime, integrated within the Epic electronic health record (EHR) system, provides tools for interactive scheduling, conflict detection for staff and equipment availability, and decision support to minimize overlaps and delays.^[95] Similarly, SurgiNet offers comprehensive OR scheduling, intraoperative documentation, and preference card management, allowing surgeons to access and update case details efficiently.^[96] Predictive analytics within these systems, often powered by machine learning, forecast delays by analyzing historical data on case durations, surgeon performance, and resource utilization; for instance, models can predict surgical times with higher accuracy than traditional methods, improving schedule adherence.^[97] Perioperative information management systems (PIMS) integrate with EHRs to streamline inventory and tracking processes in the OR. These systems capture real-time data on supplies and equipment, enabling automated documentation and reducing manual entry errors. Features like auto-replenishment trigger orders when stock levels fall below thresholds, ensuring availability of surgical items without overstocking.^[98] For example, platforms such as OperativeIQ track medical supply usage and automate reordering, integrating with hospital EHRs to align inventory with scheduled procedures.^[99] Intraoperative tools further enhance OR management through digital aids that promote safety and collaboration. Electronic checklists, implemented via tablet or integrated displays, standardize handoffs and critical information transfer between care teams, significantly improving retention of details during procedure transitions.^[100] Video integration systems support telementoring by streaming live feeds from the OR to remote experts, allowing real-time guidance on complex procedures without disrupting the surgical environment.^[101] Additionally, Internet of Things (IoT) sensors monitor equipment status, such as sterilization readiness or location, providing alerts for maintenance and preventing delays due to unavailable tools.^[102] As of 2025, advancements in artificial intelligence are transforming OR operations, with AI-driven systems providing real-time intraoperative decision support, robotic-assisted surgeries enhancing precision, and virtual reality (VR) integration for training and simulation to further improve efficiency and patient safety.^[102]^[103] Implementation of these tools requires attention to interoperability, cybersecurity, and return on investment (ROI). Standards like HL7 FHIR enable seamless data exchange between OR software and broader EHR systems, facilitating standardized APIs for real-time updates across devices and platforms.^[104] Cybersecurity measures, guided by HIPAA regulations, protect sensitive patient data in these connected environments through encryption, access controls, and regular audits to mitigate breach risks.^[105] For example, one hospital system achieved a 20 percentage point increase in first-case on-time starts through analytics-driven dashboards, demonstrating potential operational improvements.^[106]

Challenges and Innovations

Common operational challenges

Operating room (OR) management faces several persistent operational challenges that disrupt daily workflows, reduce efficiency, and compromise patient care. These issues often stem from the high-stakes, time-sensitive nature of surgical environments, where even minor disruptions can cascade into significant delays or cancellations. Among the most prevalent are scheduling conflicts, resource shortages, staff fatigue, and escalating cost pressures, each contributing to inefficiencies that affect hospital throughput and financial viability.^[107] Scheduling conflicts frequently arise from overbooking, patient no-shows, and unanticipated emergencies, leading to delays, with reported incidences ranging from 40% to 96% across cases, and cancellation rates as high as 14.4% for elective surgeries. Overbooking, which accounts for approximately 34% of surgical-related cancellations, is employed to counter no-show rates, which account for approximately 19% of cancellations in some studies—but exacerbates overruns when theatre time is depleted, occurring in 21% of cancellations overall. Add-on emergencies further intensify these issues by prioritizing urgent cases, resulting in last-minute changes for 22% of scheduled procedures and contributing to first-case start delays in approximately 27% of operations. Such conflicts not only prolong patient wait times but also strain OR utilization, with reported delay incidences ranging from 40% to 96% across cases.^[107]^[108]^[108]^[109] Resource shortages, particularly equipment downtime and supply chain disruptions, affect 5-16% of cases and hinder seamless OR operations. Equipment-related incidents, including failures or unavailability, occur in up to 15.9% of procedures, often causing delays, accounting for approximately 25% of operating room errors.^[110]^[111]^[112]^[113] Staff fatigue, driven by burnout, contributes to high turnover rates of 15-20% annually among perioperative nurses, impairing team coordination and error prevention. Burnout affects 32-50% of OR staff, with rates as high as 74% in trauma surgery teams, stemming from chronic understaffing, intense workloads, and limited breaks. First-year turnover among OR nurses reaches nearly 30%, outpacing other tenure groups and leading to knowledge gaps in high-pressure environments. This fatigue not only elevates intention-to-leave rates—up to 42.9% in some regions—but also correlates with reduced job involvement and coordination challenges during procedures.^[114]^[115]^[116]^[117] Cost pressures in OR management have intensified, with annual expense increases of 5-7% attributed to rising labor and material costs, straining hospital budgets. Labor costs surged by over 33% from 2019 to 2022, adding a $24 billion burden nationwide, while clinical labor per patient day rose 8% post-pandemic. Medical and surgical supplies, comprising 15-56% of OR budgets, saw average annual increases of 6.5% since 2017, driven by supply chain volatility and inflation outpacing hospital revenue growth at 5.1% in 2024. These pressures, where OR operations account for 25% or more of total hospital expenses, underscore the need for targeted efficiency measures without delving into broader evaluations.^[118]^[119]^[120]^[121]^[122]

Future trends and advancements

Advancements in artificial intelligence (AI) and automation are poised to transform operating room (OR) management by enhancing predictive capabilities and operational precision. Neural networks and machine learning models, such as XGBoost and modular artificial neural networks, enable more accurate forecasting of surgical case durations, improving scheduling efficiency by reducing overestimation and underestimation errors compared to traditional methods.^[123]^[124] For instance, surgeon-specific AI models have increased prediction accuracy within a 10% tolerance from 32% to 39%, potentially minimizing delays and optimizing resource allocation.^[123] In robotic-assisted surgery, AI integration facilitates real-time decision-making and intraoperative adjustments, enhancing workflow and reducing procedural variability.^[124] Sustainability initiatives are gaining momentum in OR design and operations to mitigate environmental impacts. Green ORs emphasize reusable supplies, such as textiles for gowns and drapes, which can lower energy consumption by 30-50% relative to single-use alternatives.^[125] Energy-efficient features, including LED lighting and occupancy-based HVAC systems, target reductions in energy use by 20-30% per theater, while strategies like custom surgical packs and recycling programs aim for overall waste decreases of 20-30%, addressing the fact that ORs generate 20-30% of hospital waste.^[125] These approaches not only cut costs but also align with broader healthcare goals for net-zero emissions. As of 2025, regulatory pushes for sustainable OR practices, including net-zero goals by 2030 in some regions, are accelerating adoption of these initiatives.^[121]^[125] The integration of telemedicine, accelerated by the COVID-19 pandemic, is expanding remote capabilities in OR coordination. Virtual reality (VR) platforms support immersive training simulations, boosting surgical confidence scores from 2.8 to 4.2 and improving technical performance by up to 68% among trainees.^[126] Remote consultations via telepresence and metaverse technologies enable real-time multidisciplinary collaboration, such as 5G-enabled surgical discussions, facilitating preoperative planning without physical presence.^[126] This shift enhances accessibility for patients in remote areas and supports telesurgery for expert guidance.^[126] Personalized medicine, driven by genomics, is reshaping OR resource planning through adaptive strategies. Digital twins—patient-specific virtual models incorporating genomic data—allow for preoperative simulations of genomics-guided procedures, optimizing surgical approaches and reducing intraoperative risks by tailoring to individual anatomical and physiological variations.^[127] These tools enable dynamic resource allocation, such as adjusting OR time and staffing based on predicted outcomes from tumor genomics or blood flow mapping.^[127] Building on existing digital tools, such models promise more precise, patient-centered OR management.^[127]

References

[1]
https://www.sciencedirect.com/science/article/pii/S1932227508000554
[2]
Operating Room Management - an overview | ScienceDirect Topics
We provide an overview of common concepts in OR management, specifically addressing the areas of strategic, tactical, and operational decision making (DM).
[3]
Operating room organization and surgical performance: a systematic ...
Jan 29, 2024 · This study was designed to explore how operating room organization determines surgical performance and to identify gaps in the literature that necessitate ...
[4]
Coordination Challenges in Operating-Room Management - NIH
This study analyzed information issues that impact coordination. Results demonstrate how distributed team planning is inherent to the efficacy of the system.<|control11|><|separator|>
[5]
Operating room management: why, how and by whom? - PubMed
Operating room (OR) is a cost-intensive environment, and it should be managed efficiently. When improving efficiency, shortening case duration by parallel ...
[6]
Operating Room Performance Optimization Metrics - PubMed Central
Feb 4, 2023 · By processing patients in a parallel fashion, operating room efficiency and patient throughput are increased while costs remain stable” [18].
[7]
Surgical pit crew: initiative to optimise measurement and ... - NIH
Jul 14, 2023 · Delay in turnover time (TOT) can cause meaningful disruption to perioperative operations, and TOT serves many as a key quality process measure.Missing: throughput | Show results with:throughput
[8]
How many operating rooms are needed to manage non-elective ...
Oct 28, 2015 · Depending on the demand for elective surgery, this approach could provide timely urgent and emergency surgical care at the expense of delayed ...Table 1 · Table 6 · Discussion
[9]
Strategic planning of operating room session allocation using ... - NIH
Among the three strategies of open (surgeons can choose any working day for their session), block (surgeons are assigned to a set of time blocks) and modified ...
[10]
Joseph Lister (1827-1912): A Pioneer of Antiseptic Surgery - PMC
Dec 21, 2022 · Joseph Lister helped introduce germ theory and laid the foundation for the use of antiseptics in the practice of medicine and surgery. Today, ...
[11]
Joseph Lister's antisepsis system - Science Museum
Oct 14, 2018 · Joseph Lister was the Victorian surgeon whose science-based standard of infection control, the antisepsis system, has saved countless lives.
[12]
A Brief History of the Operating Room - MedicalExpo e-Magazine
Aug 30, 2018 · Romans created the first operating "tent" around 65 AD, which became indoor in the Middle Ages. Operating theaters developed, and modern ORs ...
[13]
The Operating Room Throughout History - ADLINK Blog
Jul 27, 2020 · In the first half of the century, surgical teams established what most people today would recognize as operating rooms, and began wearing gowns, ...
[14]
A Century of Technology in Anesthesia & Analgesia - PubMed Central
In the late 1950s, anesthesiologists in the United States began to organize at the national level to tackle a longstanding need for equipment standardization.
[15]
When Designs Became Interventions in Hospitals | Journal of Ethics
In operating rooms, standardization of room designs supported standardization of surgical procedures, which reduced infections and minimized the time ...Missing: protocols | Show results with:protocols
[16]
Operating room scheduling by computer - PubMed
In order to apply computer technology to the complex surgical scheduling problem a special programming approach was devised. We discuss this approach under the ...Missing: aided 1980s 1990s
[17]
Lean in healthcare: A comprehensive review - ScienceDirect.com
Accordingly, Lean healthcare has been developing into a major strand of research since the early 2000s. The aim of this work is to present a comprehensive ...
[18]
COVID-19 in the operating room: a review of evolving safety protocols
Jul 20, 2020 · This paper attempts to look at the current relatively scarce literature and answer some questions about the readiness and methods required for conducting safe ...
[19]
[PDF] The 2018 FGI Guidelines
Nov 14, 2017 · 1.1 Location and Layout. *(4) The surgical department shall be divided into three designated areas— unrestricted, semi-restricted and restricted ...
[20]
How Is ASHRAE Standard 170 Applied to Hospital Operating Rooms?
Jul 19, 2022 · Additionally, operating rooms require positive pressurization of at least +0.01 in. w.g. as well as a minimum of 20 total air changes per hour, ...
[21]
The Complete Guide to Surgical Lighting | BFW Inc.
Aug 11, 2021 · For this reason, the IEC stipulates that surgical lights should provide between 40,000 – 160,000 LUX. Shedding a Brighter Light on LUX. LUX ...
[22]
Application Guidance - Facility Guidelines Institute
3.2 (1) (Space requirements—operating room).” ... (a) Area. Each operating room shall have a minimum clear floor area of 400 square feet (37.20 square meters).
[23]
https://fgiguidelines.org/application-guidance/
[24]
Surgical Team | Johns Hopkins Medicine
The surgical team is made up of a surgeon, an anesthesiologist, a certified registered nurse anesthetist, and an operating room nurse.
[25]
Operating Room Jobs: Who's Who in the OR? | Rasmussen University
Apr 26, 2021 · 1. Anesthesiologist · 2. Anesthesiologist Assistant (CAA) · 3. Anesthesia technician · 4. Anesthesia technologist · 5. Cardiac perfusionist · 6.
[26]
Surgical Assistants and Technologists - Bureau of Labor Statistics
Surgical technologists, also called operating room technicians, prepare operating rooms, arrange equipment, and help doctors and first assistants during ...
[27]
[PDF] AORN Position Statement on Perioperative Safe Staffing and On ...
This position statement articulates AORN's position regarding safe staffing and on-call practices for perioperative RNs based on the available research and ...Missing: fixed | Show results with:fixed
[28]
The Importance of the Optimal Nurse-to-Patient Ratio | Wolters Kluwer
California RN-to-Patient staffing ratios ; Operating Room, 1:1 ; Post-anesthesia Recovery, 1:2 ; Labor and Delivery, 1:2 ; Antepartum, 1:4.
[29]
4 Essentials to Build (And Sell) A Highly Effective Staffing Plan - AORN
Oct 22, 2019 · The target for productive staff hours worked per OR minute is usually somewhere between 0.11 and 0.13 hours per OR minute depending on the type ...
[30]
Optimizing Teamwork in the Operating Room: A Scoping Review of ...
May 17, 2024 · Specific role designation enhances clarity, accountability, and implementation effectiveness. Clear role assignments facilitate communication, ...
[31]
Common Staffing Models – Hospital Unit Administration
8-Hour (Normal Shift) Model (7.5 paid hours). Staff works 7.5-hour days, evenings and/or night shifts. · 12-Hour (Extended Shift) Models (11.25 paid hours).Missing: ratios fixed<|separator|>
[32]
The Health Care Industry and Calculating Overtime Pay
An employer's work period under the 8 and 80 overtime system must be a fixed and regularly recurring 14-day period.Missing: room | Show results with:room
[33]
[PDF] PERIOPERATIVE NURSING: - Scope and Standards of Practice
Sep 16, 2020 · Mission: AORN defines, supports, and advocates for patient and staff safety through exemplary practice for each phase of perioperative nursing ...
[34]
The American Board of Anesthesiology: Home
Initial Exams. On their way to certification, anesthesiologists take a series of three exams: BASIC, ADVANCED and APPLIED · Subspecialty Exams. Once certified, ...
[35]
CNOR - Competency & Credentialing Institute
CNOR is the only accredited certification for perioperative registered nurses, assessing knowledge and skills with a minimum of two years of clinical practice.CNOR Strong · CNOR Study Plan · Specialty Designations
[36]
Periop Nursing Certification Requirements & CNE Credentialing
Explore AORN credentialing programs like CNOR®, CSSM®, and CNS-CP®. Our certifications guide education and resources to support perioperative nursing ...
[37]
Perioperative Nursing: Scope and Standards of Practice - AORN
This 2021 edition provides a mechanism to delineate the responsibilities of RNs engaged in practice in the perioperative setting.
[38]
Begin Certification - The American Board of Anesthesiology
The BASIC Exam focuses on the scientific basis of clinical anesthetic practice: pharmacology, physiology, anatomy, anesthesia equipment and monitoring.The Basic Exam · Value of Board Certification · Subspecialty Exams · ASPEX Exams
[39]
Perioperative Training Program for Nurses - AORN Periop 101
Prep for CNOR: Helps nurses prepare for the operating room nurse certification exam. · Knowledge Assessment: Identifies clinical areas needing additional ...Perioperative Care for the Non... · A Core Curriculum · Request Information
[40]
[PDF] AORN Peri-Op 101 RN Training Program Guidelines
This program uses the AORN Perioperative 101 Curriculum for. Perioperative Operating Room O.R. Training, Orientation and Education for Nurses without previous ...
[41]
Perioperative crisis resource management simulation training in ...
Jan 18, 2024 · This narrative review delves into the contemporary landscape of simulation training in perioperative anaesthesia management.
[42]
Simulation-Based Trial of Surgical-Crisis Checklists
Jan 17, 2013 · In a high-fidelity simulation study, checklist use was associated with significant improvement in the management of operating-room crises.Study Participants · Study Design · Discussion
[43]
Perioperative Nursing Courses & Training Programs for Cont. Ed.
These online modules educate perioperative nurses on a variety of topics that go beyond the standards of care. Expand your skills with AORN today.
[44]
Continue Certification - The American Board of Anesthesiology
Have an active ABA certification in anesthesiology and/or a subspecialty, · Participate in continuous learning activities through MOCA, and · Pay the annual fee.
[45]
Sterile Technique Course - AORN
Identify the concepts of sterile technique and their application to clinical perioperative practice.Missing: operating room training
[46]
Surgical Technologist Training Program - MedCerts
In the MedCerts online Surgical Technologist training program, you will learn a range of skills, including: Operating Room Preparation; Surgical Equipment ...Certifications Earned · Program Details · Veteran Grants
[47]
Safe surgery: Tool and Resources - World Health Organization (WHO)
This starter kit will help administrators, clinicians, nurses, and other patient safety personnel walk through the process of implementing the WHO Surgical ...
[48]
Overcoming challenges in implementing the WHO Surgical Safety ...
Sep 29, 2017 · A multidisciplinary 3-day Surgical Safety Checklist training programme designed for rapid wide-scale implementation in all regional referral hospitals in ...
[49]
Periop Nursing CEU Accreditation, Disclaimer, & Copyright - AORN
AORN provides ANCC accreditation and CNE contact hours for individuals, facilities, and colleges of nursing. Find our provider credentials and more here.Missing: periods | Show results with:periods
[50]
Non-licensed Non-employee Individuals - Joint Commission
For non-licensed, non-employees that have a direct impact on patient care. E.g. HCIRs or Vendors in procedure rooms/operating rooms providing guidance to the ...Manuals & Chapter · Faq Answer · Get Extra Help And Stay...
[51]
CNOR Recertify - Certified before 2018
It begins on January 1 of the year you became certified or recertified, and continues through December 31 of the fifth calendar year. Enter your initial ...
[52]
Balancing control and autonomy in master surgery scheduling
Feb 9, 2022 · ... block plan (also called MSS), an open scheduling approach, or a mix of both called modified block plan. The main feature of tactical plans ...Methodology · Mathematical Model And... · Numerical Study
[53]
Using the theory of constraints' processes of ongoing improvement ...
... scheduling, double booking, wave, modified wave, block, and open access. Lowes (2008) describes seven scheduling systems with their advantages and disadvantages ...
[54]
Operating Room Scheduling in Teaching Hospitals - 2012
Mar 8, 2012 · In this paper, a novel mixed integer programming (MIP) model is presented for minimizing Cmax and operating room idle times in hospitals. Using ...Missing: seminal | Show results with:seminal
[55]
Surgical Duration Estimation via Data Mining and Predictive Modeling
In this study, we consider data from a large hospital and propose a hybrid method for predicting surgery duration times.
[56]
Operating room scheduling considering surgeons' preferences and ...
In this study, we focus on an OR scheduling problem for a Korean university hospital with 32 ORs, in which the surgeons' preferred rooms and times are ...
[57]
Simulation-based evaluation of operating room management policies
Mar 24, 2021 · First In First Out (FIFO): The sequencing of expected surgery durations follows no explicit sorting policy. Concerning surgery durations, the ...
[58]
A systematic review of patient prioritization tools in non-emergency ...
Patient prioritization tools (PPTs) are paper or computer-based instruments that support patient sorting using criteria, often for non-emergency settings.
[59]
Application of Operational Research Techniques in Operating Room ...
This study examined 170 planning and scheduling studies related to operating rooms scanned in the databases of the Emerald, Science Direct, JSTOR, Springer, ...2. Patient Features · 3. Performance Criteria · Table 2
[60]
Determining optimum operating room utilization - PubMed
Using a simulated operating room (OR), the authors demonstrate that OR utilization higher than 85% to 90% leads to patient delays and staff overtime.Missing: 80-85% | Show results with:80-85%
[61]
Surgical Site Infections | PSNet
SSIs are the most common preventable complication after surgery, occurring in 2% to 4% of all patients undergoing inpatient surgical procedures.
[62]
Hand hygiene - Infection prevention and control
The WHO Guidelines on hand hygiene in health care outline hand hygiene recommendations and are complemented by the WHO Multimodal hand hygiene improvement ...Five moments for hand hygiene · WHO guidelines on hand · Training tools
[63]
Infection Prevention: The Latest on Surgical Attire Recommendations
Jan 10, 2022 · AORN's evidence-based surgical attire guideline promotes cleanliness in the surgical space to protect patients and personnel from transmission of pathogens.
[64]
Implementing the Aseptic Non Touch Technique (ANTT®) clinical ...
Aug 4, 2017 · Aseptic technique is an important infection prevention competency for protecting patients from healthcare-associated infection (HAI).
[65]
ASHP/SIS/SHEA/IDSA Guidelines for Antimicrobial Prophylaxis in ...
Feb 1, 2013 · The guidelines are intended to provide practitioners with a standardized approach to the rational, safe, and effective use of antimicrobial agents.
[66]
C. Air | Infection Control - CDC
Dec 21, 2023 · Laminar airflow is designed to move particle-free air over the aseptic operating field at a uniform velocity (0.3–0.5 m/sec), sweeping away ...
[67]
Selected EPA-Registered Disinfectants | US EPA
Sep 11, 2025 · This page contains information on certain EPA-registered disinfectants, including links to lists of products registered against common ...Disinfectants for Emerging · Coronavirus and Disinfectants · Pesticide Registration
[68]
Standard Precautions for All Patient Care | Infection Control - CDC
Apr 3, 2024 · Perform hand hygiene. · Use personal protective equipment (PPE) whenever there is an expectation of possible exposure to an infectious material.Transmission-Based Precautions · Hand Hygiene Guidelines · Clinical Safety
[69]
Sterilizing Practices | Infection Control - CDC
Nov 28, 2023 · The sterilization procedure should be monitored routinely by using a combination of mechanical, chemical, and biological indicators to evaluate ...
[70]
SSI | PSC | NHSN - CDC
A comprehensive guide to NHSN's SIR, including risk factors used in the SIR calculations under the 2015 baseline.
[71]
Outbreak Response and Incident Management: SHEA Guidance ...
This expert guidance document was developed as a resource to provide healthcare epidemiologists working in acute-care hospitals with a high-level overview of ...Missing: tracing | Show results with:tracing
[72]
Summary of Recommendations | Infection Control - CDC
Apr 12, 2024 · Do not use laminar air flow systems in newly constructed PE rooms. II. C.III.F. Take measures to protect immunocompromised patients who would ...
[73]
Proactive Perioperative Risk Analysis: Use of Failure Mode and ...
FMEA is a tool for process analysis, assessing steps, identifying failure sites, and evaluating causes and effects to decrease risks.
[74]
Operating Room Codes Redefined: A Highly Reliable Model ... - PMC
Apr 12, 2019 · An intraoperative cardiac arrest, also known in some settings as a “code blue,” is defined as an event during the care of an anesthesia care ...
[75]
Massive Transfusion - StatPearls - NCBI Bookshelf
Sep 15, 2025 · A massive transfusion involves the administration of 10 units or more of whole blood or packed red blood cells (PRBCs) within 24 hours.Continuing Education Activity · Introduction · Indications · Equipment
[76]
Lessons Learned from an Operating Room Emergency Evacuation ...
In this article we describe the planning and execution of this drill and some of the lessons that were learned as a result of the exercise.
[77]
Safety: Simulate Emergencies in Bedside Mock Drills - AORN
Jan 14, 2020 · Safety: Simulate Emergencies in Bedside Mock Drills; Let staff practice their response to urgent situations before they occur.<|separator|>
[78]
Complications in Surgery: Root Cause Analysis and Preventive ...
The purpose of this paper is to introduce root cause analysis as a tool for identifying the causes of surgical complications.
[79]
Sentinel Event Policy and Procedures - Joint Commission
The Joint Commission adopted a formal Sentinel Event Policy in 1996 to help hospitals that experience serious adverse events improve safety and learn from those ...
[80]
Key metrics to improve your operating room utilization | Our Insights
Oct 20, 2023 · Our podcast discusses how data analytics can be used to improve the metrics that drive your success in the OR.Missing: throughput | Show results with:throughput
[81]
[PDF] FIRST CASE STARTS AND TURNOVER TIME by Caitlin Thayer
Apr 24, 2015 · OR efficiency incorporates how well time and resources are utilized; OR utilization measures the OR's capacity and has a best practice target of ...
[82]
Identification and use of operating room efficiency indicators - NIH
First case start-time accuracy measures the percentage of first cases of the day that start on time. An on-time start is typically defined as the patient ...
[83]
Assessment of Incorrect Surgical Procedures Within and Outside the ...
Nov 21, 2018 · The overall VHA in-OR reported adverse event rate was 0.53 per 10 000 procedures based on 3 234 514 in-OR procedures. This rate is slightly ...
[84]
Patient Satisfaction and Surgical Quality - JAMA Network
This observational study reports that hospital performance on a patient satisfaction survey is associated with objective measures of surgical quality.
[85]
Effects on Operating Room Costs for Total Hip and Knee Arthroplasty
Dec 14, 2021 · The average direct per-case supply cost ranged from $4955 to $5271 for total knee arthroplasty (TKA) and $5469 to $5898 for total hip arthroplasty (THA) during ...
[86]
ACS National Surgical Quality Improvement Program
The ACS NSQIP is a variable-based data registry designed to improve hospital-wide quality across all surgical departments.ACS NSQIP Participant Use... · FAQs · Nsqip & qvp · (ACS NSQIP ® ) is at the...
[87]
Analysis of the Application Effect of PDCA Cycle Management ...
Mar 17, 2022 · PDCA cycle management combined with risk factor management nursing is implemented in infection management of operating rooms in our hospital.Research Methods · Observation Index · Discussion
[88]
Study on the Effect of PDCA Circulation Method on Nursing Quality ...
May 12, 2022 · PDCA circulation nursing management in the day operating room could optimize the nursing quality management, improve the satisfaction rate of the operating ...2.2. Methods · 3. Results · 4. Discussion
[89]
OR Capacity - Epic
The interactive OR Marketplace allows surgeons and staff to browse and request OR time as it becomes available. Marketplace notifications can also automatically ...Missing: SurgiNet | Show results with:SurgiNet
[90]
What is SurgiNet? Competitors, Complementary Techs & Usage
May 21, 2025 · SurgiNet was a system by Cerner to facilitate real-time documentation and information access in the operating room, improving workflow and ...Missing: features | Show results with:features
[91]
Effect of a Predictive Model on Planned Surgical Duration Accuracy ...
Jan 27, 2021 · To improve accuracy in predicting surgical case duration, we developed a set of predictive models that leveraged the recorded information (more ...
[92]
https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/
[93]
Inventory and Asset Management - OperativeIQ
OperativeIQ manages medical supply inventory, tracks usage, reorders, and manages high-value assets, including maintenance and location tracking.
[94]
An electronic checklist improves transfer and retention of critical ...
An electronic checklist improves transfer and retention of critical information at intraoperative handoff of care. Citation Text: Agarwala A, Firth PG ...
[95]
Leveraging Videoconferencing Technology to Augment Surgical ...
A multimodal approach using videoconferencing tools to augment residents' operative experience through remote broadcasting of surgical procedures, telecoaching ...
[96]
8 Technologies Enhancing Operating Room Efficiencies - DelveInsight
Jun 30, 2025 · As a core component of the digital operating room, IoT devices enable real-time tracking of critical assets—from surgical instruments to ...
[97]
FHIR Specification - HL7.org
No information is available for this page. · Learn whyMissing: operating room<|control11|><|separator|>
[98]
Summary of the HIPAA Security Rule | HHS.gov
Dec 30, 2024 · The Security Rule establishes a national set of security standards to protect certain health information that is maintained or transmitted in electronic form.
[99]
Operating Room Excellence: How One Hospital System is Driving ...
Using advanced data and analytics tools, the organization improved operational efficiency in operating rooms, achieving significant results, including a 20 ...Missing: ROI | Show results with:ROI<|control11|><|separator|>
[100]
Prevalence and Causes of Elective Surgical Cancellations - PMC
Jan 15, 2023 · The prevalence of elective surgical case cancellations was 14.4% in our hospital, higher than the international benchmark of 5%.
[101]
Assessing the Rates and Reasons of Elective Surgical ... - NIH
Nov 16, 2021 · Our multicentre study found an over-run of OT time (21.3%), patients failing to show-up for admission (19.3%), and a last-minute change in the ...Missing: statistics | Show results with:statistics
[102]
[PDF] Operating Room Delays - Duke School of Nursing
2,10,11 There is wide variation in the reported occurrence of OR delays, with rates ranging from 40% to 96% of all cases. 3,6,12 Surgical delays are often due ...<|separator|>
[103]
Equipment-related incidents in the operating room - Ovid
Jun 16, 2010 · In this study, we have found that equipment-related incidents in the OR are a common phenomenon, occurring in up to 15.9% of surgery procedures.Missing: downtime | Show results with:downtime
[104]
Delays in the operating room: signs of an imperfect system - PMC
Delays in the operating room have a negative effect on its efficiency and the working environment. In this prospective study, we analyzed data on ...Missing: buffers | Show results with:buffers
[105]
[PDF] Medical Device Supply Chains Project Report
The U.S. supply chain for COVID-19 relevant medical devices, such as personal protective equipment (PPE), ventilators, and testing supplies and equipment, was ...
[106]
Issues in the U.S. Hospitals' Supply Chain System
Apr 29, 2025 · According to Becker's Hospital Review, more than 80% of healthcare organizations across the nation faced shortages after Hurricane Helene ...Missing: downtime statistics
[107]
https://pmc.ncbi.nlm.nih.gov/articles/PMC9859182/
[108]
Understanding burnout among operating room nurses: a qualitative ...
May 26, 2025 · In a study by Ramuszewicz et al. (15) 32% of operating room nurses reported experiencing occupational burnout. In China, the situation is ...
[109]
Staffing Shortages and Nurse Burnout | OR Today
May 1, 2024 · What's more, first-year turnover among OR nurses was nearly 30% last year, outpacing all other tenure categories, according to the 2023 NSI ...Missing: annual | Show results with:annual
[110]
Perioperative Nursing Shortages: An Integrative Review of Their ...
Aug 19, 2024 · Reportedly, the turnover rate of perioperative nurses is between 13% and 75% in their first three years working in this specialty [88, 123, 159] ...
[111]
Agency Staffing and Hospital Financial Performance - NIH
Oct 4, 2024 · Hospital labor costs increased by over one-third between 2019 and 2022, resulting in an additional financial burden of $24 billion. As a result, ...
[112]
Drastic increase in hospital labor costs led to a sustained financial ...
The clinical labor costs have increased by an average of 8% per patient day compared with the prepandemic data reported in the 2019 Medicare Cost Report. Thus, ...Missing: percentage | Show results with:percentage
[113]
Changes in Hospital Medical Supply Costs - Definitive Healthcare
Jan 10, 2025 · Medical and surgical supply costs increased by 6.5% on average since 2017 · Total hospital supply expense averages more than $43 million.Missing: room | Show results with:room
[114]
Costs of Caring | AHA - American Hospital Association
particularly in areas driven by labor and supply chain pressures.
[115]
Exploring the Financial Impact of Operating Rooms on Hospital ...
Studies show that 25% or more of hospital expenses come from OR operations. A large part of these costs come from labor, surgical supplies, equipment upkeep, ...
[116]
Machine Learning Approach to Predict Case-Time Duration
Machine learning approaches can improve case duration estimations, enabling improved operating room scheduling, efficiency, and reduced costs. Section ...
[117]
Artificial Intelligence in Operating Room Management | Journal of ...
Feb 14, 2024 · This systematic review examines the recent use of artificial intelligence, particularly machine learning, in the management of operating rooms.
[118]
Green Surgery and Sustainability in Orthopaedic Operating Rooms
Aug 31, 2025 · Sustainability initiatives in orthopaedic operating rooms can significantly reduce energy consumption and waste production. However ...
[119]
a global mixed-methods study of VR, metaverse, and 3D simulation ...
Sep 7, 2025 · Discussion: Immersive technologies significantly enhance medical education and procedural training, demonstrating cross-regional applicability.
[120]
Digital twins for the era of personalized surgery - Nature
May 15, 2025 · Digital twins can aid surgeons in training and in performing interventions with greater awareness and precision.