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5 tips to accelerate ORs through perioperative efficiency

As the demand of care services and surgical waiting lists grows, maximizing opportunity cost and capacity is as a top concern for hospitals. In this blog post we provide 5 tips to increase operating room efficiency by changing perioperative journeys.

Matilde Ferreira

Matilde Ferreira

January 26, 2023 · 10 min read

Operating departments (OR) are hot spots, accountable for the largest part of hospital costs and production. Specifically, ORs contribute to almost two-thirds of a hospital’s total revenue, but also account for about 40% of their total expenses1, including manpower and operating costs.
Maximize cost opportunity and capacity is, therefore, a top priority for providers facing an always growing demand of care services, including surgery.

Back to basics: efficiency is not rocket science

When it comes to the future of surgery, medical technology experts often try to predict what’s to come to get ahead of the latest trends. In the last decade, we’ve seen an explosion of new products in a range of high-tech areas: big data, artificial intelligence and machine learning play an increasingly relevant role in treatment planning, decision-making and best practices adoption, while augmented reality, mixed reality and robotics are pointed as essential technologies that impacting surgical devices.
These fancy concepts can sound overwhelming, far away from reality – and quite expensive –, but there is good news: the main driver of efficiency improvement is process improvement. Perhaps not so fancy, but cost-effective.
Efficiency has been described as the capacity of performing things in a way that leads to cost reduction without affecting quality. Other authors define efficiency as the ability of doing the right things, combining productivity and quality2. In turn, quality of care is understood as “the extent to which health care services provided to individuals and patient populations improve desired health outcomes”, being safe, effective, timely, efficient, equitable, and people centered3.
For the purpose of this blog post, let’s consider efficiency as the ability to increase capacity and quality, while reducing costs.
Top tips to improve surgical journeys through perioperative efficiency.

1. Implement a surgical pathway and keep single source of truth for each professional to improve visibility and collaboration

Perioperative efficiency starts way before the surgery. Missing patient information preceding the surgery can lead to wrong surgical decisions and time lost. This is particularly relevant in complex diseases with multidisciplinary approaches. 
For example, operating a cancer patient without multidisciplinary agreement on the treatment recommendation may lead to poorer clinical outcomes and, thus, extra medical expenditure.
What’s missing? A plan and one source of truth for all professionals to have a shared understanding of the patient status.
Creating an efficient perioperative journey is much like leading an orchestra. There is a pre-defined pathway to be followed – the music staff – a unique source of truth in real time – the conductor – a lot of intricate moving parts – musical instruments. All of them must be in tune, the rhythm succinct. If one instrument is out of tune or loses the beat, it will throw off the entire performance.
As an orchestra, perioperative journeys bring together multiple specialties and professionals working side by side - surgeons, anesthesiologists, diagnostic technicians, among others. There is a care plan to be followed, detailing sequentially framed activities that must be performed and several decisions to be made, considering the patient condition, comorbidities, exams results, etc. But a one and only, real time updated source of truth is still lacking.
What’s missing?
  1. A clinical pathway, comprehensive enough to cover pre, intra and post OR tasks.
  2. A single source of truth, changing dynamically based on the clinical pathway.
This way all professionals to have a shared understanding of the patient status.
In practice:
  • Create a multidisciplinary care plan for surgery. You can start easy by building a generic care plan for surgery (ambulatory vs programmed) and then specify per pathology or procedure.
  • Have full and real time visibility of patient progress on the care plan.
  • Make sure that the software used to follow the care plan communicates with other systems in use and is automatically updated as new data is available.

2. Stratify patients to avoid cancellations due to unexpected clinical conditions

As discussed on the previous blog post, surgery cancellation is the leading cause of operating room inefficiencies4. Specifically, day of surgery (DOS) cancellations represent a significant loss of revenue and waste of resources, increasing the already extensive waiting lists that must accommodate the burden of cancelled operations, and most of them are preventable.
For example, admitting a high-risk patient without proper anesthetic risk stratification (ASA) in the OR will surely lead to the surgery being cancelled.
Around 30% of cancellations happen due to clinical reasons5 that could beneficiate from more accurate perioperative evaluation and stratification, including6:
  • Documentation of the condition(s) for which surgery is needed;
  • Uncovering of hidden conditions that could cause problems both during and after surgery;
  • Perioperative risk determination;
  • And optimization of the patient’s medical condition in order to reduce the patient’s surgical and anesthetic perioperative morbidity or mortality.
Preoperative medical assessment has proven its worth to reduce elective case cancellations. In particular, a significant reduction is found in cancellations for medical reasons7.
In practice:
  • Include eligibility criteria and exclusion criteria in your surgical clinical pathways;
  • Use risk stratification scores and validated questionnaires;
  • Anticipate the perioperative stratification to make sure that our teams have the information needed to decide timely;
  • Create clear decision criteria for a go-decision for surgery, including who needs be informed.

3. Automate repetitive tasks to free surgeons and anesthetists’ time

Keeping up with the orchestra metaphor, there are a lot of activities surrounding a live concert which are not performed by musicians to let them focus on their best talent – playing. Our suggestion is about doing the same in your hospital. Learn more about how to choose which activities must be automated.
From efficiency improvement perspective, automation is useful within two major scopes:
  1. Patient assessment and stratification before surgery, improving seamless patient navigation and reducing last minute cancellations due to clinical reasons.
  2. Patient follow-up after surgery increasing patient safety and physicians’ confidence on early discharges.
Automation is revolutionizing many industries, including healthcare, enabling hospitals to outsource and offload their most time-consuming work, help relieve administrative burdens and enable healthcare staff to refocus their energy on patients. Such ability looms large when almost half of physicians across all specialties report feeling burned out8 and nearly 60% outline “too many bureaucratic tasks” as the main cause9. Thinking on surgical departments, statistics show that general surgery residents spend at least 30% of their time using the EHR and anesthetists spend almost 20% of their time on administrative work11.
In practice:
  • Use an omnichannel approach (SMS/Voice/Web) to automatically collect patient data before appointments/surgery.
  • Stratify patients automatically, using validated questionnaires and EHR interoperability capabilities able to interpret the information received.
  • Provide your teams with the information in an actionable way, meaning they can fast track low risk patients for surgery and invest their time and knowledge on complex patients.
  • Use your EHR interoperability capabilities to automate pre-surgery exams prescription and automatically generate medical records.
  • Use the same communication engine to follow-up patients after surgery to prevent rehospitalization without increasing teams’ workload.

4. Empower patients and promote evidence-informed behaviors

Going under surgery can be overwhelming and patient education about surgery, anesthesia, intraoperative care, and postoperative pain treatments in the hope of reducing anxiety, improving compliance with pre-surgery recommendations, and facilitating recovery. This improves surgical outcomes and reduces no-shows.
Back to the orchestra, one cannot expect that “ordinary” people assisting to a particular play for the first time will get deep understanding of the several layers presented on a single artistic expression.  Approaches found to overcome those cultural literacy asymmetries range from simple synopsis to cultural mediation programs that offer public a chance to explore the historical, sociological, and artistic background of a particular performance.
A similar method is required to make sure patients feel comfortable proceeding with their surgeries, reduce no shows or low adherence to the pre-surgery treatment plan, making the surgery unfeasible. Did you know that patients not showing up account for 1 out of 5 cancellations12 and 50% of patients13 report increased anxiety levels  due to a lack of communication and information from the practice staff?
In practice:
  • Provide patients with information adapted to their health literacy level, about the disease and perioperative journey.
  • Make sure they know how to navigate care – what to do – every step of the way.
  • Keep regular points of contact to increase their confidence on self-management.
  • Provide them an intuitive and fast channel to report any red flag, increasing the perception of close monitoring by health teams.
Note: to further insights on the importance of having evidence guiding society behaviors read our blog post Evidence-informed health: post COVID-19 lessons.

5. Build a continuous improvement culture through a lean management system

In the perioperative setting, every minute wasted erodes quality and financial well-being. Using lean methodologies to address these issues can make an enormous difference in quality, efficiency, and productivity.
The Lean method initially studied at the Massachusetts Institute of Technology to improve efficiency by eliminating "non-value added" activities known as waste. In addition, the method was applied in different settings related to clinical process to remove waste, identify inefficiencies, and improve outcomes.
In practice:
  • Standardize collaterals processes such as sterile processing and inventory, labs, and scheduling.
  • Standardize workflows for setup time, instrument flow, and post-operative transfer.
  • Constantly monitor and analyze bottlenecks, to demonstrate the problem and convince people that the solution chosen in the right one.


  • Maximizing operating room efficiency has important implications for cost savings, patient satisfaction, and medical team productivity.
  • Although time consuming, process mapping of each step of the patient journey from pre-operative visit to post-operative discharge have multiple benefits related to costs reduction and quality improvement.
  • Enhanced collaboration of multiple professionals and care levels, patient stratification and automation arise as key points to increase capacity.
If you are a Hospital Director looking to opportunity cost optimization, or a Clinical Director who needs to reduce hospital waiting times and prevent readmissions or even a Head of Operating Room striving to reduce no shows and surgery cancellation, get in touch.


  1. Oh HC, Phua TB, Tong SC, Lim JFY. Assessing the Performance of Operating Rooms: What to Measure and Why? Proceedings of Singapore Healthcare. 2011;20(2):105-109. doi:10.1177/201010581102000206
  2.  Erebouni Arakelian, Lena Gunningberg, Jan Larsson, How operating room efficiency is understood in a surgical team: a qualitative study, International Journal for Quality in Health Care, Volume 23, Issue 1, February 2011, Pages 100–106,
  3. Quality of Care. (n.d.). Retrieved January 20, 2023, from
  4. Abate, S. M., Chekole, Y. A., Minaye, S. Y., & Basu, B. (2020). Global prevalence and reasons for case cancellation on the intended day of surgery: A systematic review and meta-analysis. International journal of surgery open, 26, 55–63.
  5.  Gillies, M. A., Wijeysundera, D. N., & Harrison, E. M. (2018). Counting the cost of cancelled surgery: a system wide approach is needed. British journal of anaesthesia, 121(4), 691–694.
  6. Zambouri A. (2007). Preoperative evaluation and preparation for anesthesia and surgery. Hippokratia, 11(1), 13–21.
  7. Knox, M., Myers, E., & Hurley, M. (2009). The impact of pre-operative assessment clinics on elective surgical case cancellations. The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland7(2), 76–78.
  8. Carbajal, E. (n.d.). 29 physician specialties ranked by 2021 Burnout rates. Retrieved January 20, 2023, from
  9. Wolstenholm, J. (2022, November 18). Physician burnout in 2022: Everything you need to know. Retrieved January 20, 2023, from
  10. Cox, M. L., Farjat, A. E., Risoli, T. J., Peskoe, S., Goldstein, B. A., Turner, D. A., & Migaly, J. (2018). Documenting or Operating: Where Is Time Spent in General Surgery Residency?. Journal of surgical education, 75(6), e97–e106.
  11. Compère, V., Besnier, E., Clavier, T., Byhet, N., Lefranc, F., Jegou, F., Sturzenegger, N., Hardy, J. B., Dureuil, B., & Elie, T. (2022). Evaluation of the Time Spent by Anesthetist on Clinical Tasks in the Operating Room. Frontiers in medicine, 8, 768919.
  12. Kumar, R., & Gandhi, R. (2012). Reasons for cancellation of operation on the day of intended surgery in a multidisciplinary 500 bedded hospital. Journal of anaesthesiology, clinical pharmacology, 28(1), 66–69.
  13. Mekonen, Semagn & Ali, Yigrem & Basu, Bivash. (2020). Global Prevalence and determinants of preoperative anxiety among surgical patients: A systematic review and Meta-analysis. 10.1016/j.ijso.2020.05.010.
Matilde Ferreira

Matilde Ferreira

Content Strategy & Communication Manager

Graduated in Communication Sciences, early on fell in love with storytelling. Started off as a journalist and then pivoted to the public relations world, she was always driven to craft relevant stories and bring them to the stage.

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