Image by mibro from PixabayFor ambulatory surgery centers (ASCs), success across a variety of areas can be linked back to operating room efficiency.
OR efficiency is critical for ASCs because it directly impacts a facility’s ability to maximize case volume and revenue within limited operating hours. Efficient OR booking ensures optimal utilization of surgical time, while fast, safe turnover between procedures minimizes downtime, improves patient flow and enhances surgeon satisfaction.
Together, these efficiencies support both clinical excellence and financial performance.
“Reducing recovery time doesn’t mean compromising care,” Erica Palmer, HST Pathways’ communications director, told Ambulatory Surgery Center News. “It’s about optimizing the process to ensure that patients recover safely and efficiently.”
HST Pathways is a health care technology company that offers cloud-based software solutions for ASCs.
Each year, HST Pathways releases its annual State of the Industry report, taking a deep dive on key ASC data from the last year. The report – based on de-identified data from about 590 ASC clients across the U.S. – covers a wide range of topics, but its insights around OR efficiency are particularly illuminating.
One insight from the report: Facilities with only two ORs consistently achieved higher utilization rates, around 61.6%, compared to those with more than 15 ORs. What’s more, ASCs with several ORs also saw an 8% decline in growth year over year, according to the report.
“These trends suggest a shifting dynamic in ASC performance, with smaller centers thriving while larger ones face headwinds,” the report explains.
The HST Pathways report also explores average turnover time across specialties. For example, orthopedics had a roughly 21.1-minute turnover time, behind only plastic surgery at 22.6 minutes. General surgery, pain management and ENT all hovered around the 16 to 18 minute range.
A systematic approach can help reduce turnover times, Palmer said.
“Turnover times could be improved by implementing checklists, clearly documenting staff protocols and cross-training staff,” she said.
Another approach to boost OR efficiency that some centers have adopted is implementing what Palmer called a “pit crew.” Designating a dedicated team, much like a NASCAR pit crew, that focuses solely on turning over the OR can significantly reduce idle time between cases, she said.
“The pit crew’s only job as staff members was to come in and clean up the OR and get it ready for the next case,” she said. “So it wasn’t like one or a few nurses in the room were trying to do everything. … Everyone really had their lanes, and that ended up reducing turnover time for them – pretty significantly.”
Beyond OR turnover, the data in the report revealed large variances in average OR duration by specialty. Plastic surgery was at 156.0 minutes, while orthopedics averaged nearly 70 minutes. Meanwhile, procedures such as gastroenterology and pain management ran under 20 minutes.
Centers should pay close attention to year-over-year shifts within each specialty, even if an increase appears minimal, Palmer said.
Orthopedic procedure turnover times, for example, grew by an average of 1 minute from 2023 to 2024.
“That may seem insignificant,” she said. “But if you’re doing, let’s say, 150 cases per month, that’s over $14,000 in potential revenue. Every minute counts.”
Many facilities also grappled with delays between scheduled start times and actual start times, most notably in general surgery, where the average delay was more than 27 minutes, according to the report. Cardiology saw an average delay of 19 minutes, while pain management saw a 16.6-minute lag.
To combat this, some ASCs institute a strict policy for first-case-on-time starts, Palmer said.
“A lot of ASCs have first-case-on-time start policies, meaning if the first case of the day starts late, they actually will cancel or postpone it, to avoid that trickle effect of delays for the entire schedule,” she said.
Cancellation rates can also impact OR efficiency.
“The patient canceling is No. 1, but the second is the provider canceling,” Palmer said. “[It’s worth looking into] why the surgery center cancelled. Was it because of equipment? Was it something … out of everybody’s control, or was it something that could have been fixed?”
