A “swing room” model based on regional anesthesia reduces turnover time and increases case throughput

A regional anesthesia-based “swing” operating room model reduces non-operative time in a mixed orthopedic inpatient/outpatient population

“…For example, in upper extremity surgery, use of brachial plexus blockade (BPB) rather than general anesthesia (GA) leads to reduced postoperative pain and analgesic requirements, [5][6][7][8][9][10][11][12][13] decreased postoperative nausea and vomiting (PONV), [5][6][7][8][9]13 and reduced length of stay in the postanesthesia care unit (PACU). [6][7][8][9][10][11][12][13][14] The recent introduction of ultrasound technology has led to an increased interest in regional anesthesia as its use is associated with numerous advantages, including the potential for accelerated onset times and greatly improved success rates. [15][16][17] These attributes render ultrasound-guided regional anesthesia an attractive component of perioperative care models targeted to increase efficiency and throughput.…”

“…The model is based on ultrasoundguided regional anesthesia and parallel processing. 13 In this model, care is provided in two operating rooms and an adjacent multipurpose unit that serves simultaneously as a preoperative admission area, an ultrasound-equipped regional anesthesia room, and a postoperative recovery area. This ''swing'' room model involves one single anesthesiologist with one anesthesia assistant, four nurses, a surgical assistant, and one single attending surgeon who ''swings'' between the ORs to operate on patients in whom regional anesthesia is present upon OR entry.…”

“…We recently reported that this outpatient-based model is associated with a decreased turnover time and increased throughput compared with the traditional model of GA in a single OR. 13 However, this model may not be readily reproducible in hospitals treating a mixed inpatient/outpatient case load that includes procedures of longer duration. In November 2008, we introduced a ''swing'' room model in the main OR suite.…”

“…These were different patients from those in the ambulatory cohort of Outpatient Department Surgical Procedure Room patients studied in our recent report, and they were also treated in a different facility. 13 The Research Ethics Board waived the requirement for informed consent from the individual subjects. We matched swing room model cases with historical control cases completed from 2006 to 2010 under GA in the context of a conventional ''single surgeon-single anesthesiologist-single OR'' model as closely as possible (i.e., identical anatomical location and surgical procedure).…”

“…19 As a secondary outcome variable, we estimated case throughput, which we expressed as the median number of comparable cases possible in an eight-hour day (beginning at the time of surgical incision on the first patient of the day) and calculated using the formula below 13 :…”