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Suzanne M. Sokal, MSPH; David L. Craft, PhD; Yuchiao Chang, PhD; Warren S. Sandberg, MD, PhD; David L. Berger, MD

Arch Surg. 2006;141:389-395.

Hypothesis  Three parallel processing operating rooms (ORs) (concurrent induction and turnover) with a dedicated 3-bed mini–recovery room (mini–postanesthesia care unit [PACU]) will optimize patient throughput and main PACU workload when compared with 4 traditional ORs or 4 parallel processing ORs.

Design  Statistical and mathematical models projected the impact of parallel processing on case throughput and PACU use.

Setting  Academic medical center with 48 traditional ORs using serial induction and turnover and 1 experimental OR, the operating room of the future, with parallel processing.

Participants  All surgical cases from October 2002 through March 2004 (N = 49 887).

Interventions  A statistical model projected the duration of induction, surgery, turnover, and PACU stay for cases performed in a traditional OR (n = 48 667) based on the operating room of the future (n = 1220) experience. A fluid queuing model compared each combination using specific probability density functions.

Main Outcome Measures  Each OR configuration was evaluated for case throughput and minutes of work sent to the PACU.

Results  Although all cases save OR time with parallel processing, only select surgeon-case combinations translate time saved into additional cases per day (26%). Without additional PACU slots, output from 4 parallel processing ORs further stresses the PACU. Three parallel processing ORs and a mini-PACU balances incremental volume by offsetting PACU utilization in 84% of cases.

Conclusion  In a PACU-constrained environment, 3 parallel processing ORs with a mini-PACU configuration offers increased throughput and decreased PACU workload.

Author Affiliations: Center for Clinical Effectiveness in Surgery and Departments of Surgery (Drs Sokal and Berger), Radiation Oncology (Dr Craft), Medicine (Dr Chang), Anesthesia and Critical Care (Dr Sandberg), Massachusetts General Hospital, and Harvard Medical School (Drs Sandberg and Berger), Boston.

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