Measuring Operating Room Efficiency: The Metrics That Matter Most

The Importance of Operating Room Efficiency

Operating room (OR) time is among the most valuable and costly resources in a surgical facility. Despite this, many centers rely on basic metrics such as case volume or scheduled start times to assess performance. A more strategic approach involves tracking a refined set of key performance indicators (KPIs) that highlight inefficiencies, support targeted interventions, and validate workflow improvements.

Essential Metrics for Assessing OR Performance

A comprehensive efficiency strategy includes the following high-impact metrics:

First-Case On-Time Start (FCOTS)
FCOTS measures the percentage of first cases that begin at their scheduled time. Delays in this area can disrupt the entire surgical schedule, leading to overtime, patient dissatisfaction, and provider fatigue. Monitoring FCOTS helps ensure accountability and promotes upstream process improvements.

Turnover Time (TOT)
TOT refers to the interval between one patient exiting the OR and the next patient entering. It reflects the effectiveness of coordination among nursing, sterile processing, and anesthesia teams. Reducing turnover time without compromising safety requires well-defined protocols and consistent execution.

Anesthetic Control Time
This metric includes both induction and emergence phases. Variability in anesthetic control time can affect case duration and recovery efficiency. Experienced anesthesia providers who follow standardized protocols can reduce variation and promote smoother transitions in care.

Post-Anesthesia Care Unit (PACU) Length of Stay
PACU efficiency impacts patient flow, staffing needs, and case throughput. Monitoring average length of stay in PACU helps identify areas where pain control, nausea management, or communication delays may be causing discharge bottlenecks.

Cost per Anesthetized Minute
This financial metric calculates the average cost of delivering anesthesia services per minute a patient is under care. It incorporates personnel, medication, and equipment use, and serves as a valuable benchmark for both budget oversight and process optimization.

Creating a Functional OR Efficiency Dashboard

To make these metrics actionable, facilities should automate data collection and display it through a centralized dashboard. Best practices include:

  • Automating time capture using integrated electronic medical records (EMR) and anesthesia information management systems.
  • Using rolling 90-day averages to identify trends and reduce the impact of one-time anomalies.
  • Linking metrics to operational actions, such as triggering a multidisciplinary team huddle if FCOTS compliance falls below a defined threshold.

The Anesthesia Team’s Role in Efficiency

Certified Registered Nurse Anesthetists (CRNAs) play a critical role in driving OR efficiency. Their expertise in rapid induction, airway assessment, and multimodal analgesia supports timely starts, shorter PACU stays, and consistent emergence times. By collaborating in real-time with surgeons and nursing teams, anesthesia professionals contribute directly to four of the five key metrics outlined above.

Final Insight: Efficiency Depends on Consistency, Not Speed

True OR efficiency is not about rushing through procedures. It is about establishing repeatable systems, maintaining clear communication, and delivering high-quality care within predictable timeframes. Partnering with an anesthesia group that prioritizes protocol-driven practices and flexibility in staffing helps ensure that cases stay on time without sacrificing safety or outcomes.

When surgery centers can’t find anesthesiologists, their operating rooms sit empty. We change that by delivering reliable anesthesia services to keep things moving. It leads to better patient care and no lost revenue.
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425.615.6100

Email

info@advancedanesthesiaservices.com

Mailing Address

35302 SE Center St Snoqualmie, WA 98065
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Thomas Nigro, Jr., Chief CRNA

Tom is a driven individual and supportive teammate. He received a Bachelor of Science degree in Biology from John Carroll University before completing his nursing training, Masters of Science, and Doctor of Nursing Practice degree from DePaul University. Tom’s CRNA training was through NorthShore University Health System School of Nurse Anesthesia. During his time at NorthShore he researched the topic of Substance Use Disorder and his work has subsequently been published. Tom recognizes that each person is unique. His careful examination of patient needs, and willingness to utilize progressive anesthesia practices provide for an individualized and excellent perioperative experience.
Christine Wilcock, Financial Officer

Christine Wilcock

Christine oversees the accounting and business development aspects of Advanced Anesthesia Services. She earned her accounting degree in 2010 and is experienced in all areas of medical accounting and billing. She is dedicated to our customers, ensuring the high-quality care our patients receive in the operating room continues through the billing and insurance payment process. Christine lives in Snoqualmie, Washington and has three children.
Allyn Wilcock, CEO

Allyn Wilcock

Allyn is the owner and oversees clinical operations at Advanced Anesthesia Services as well as Northwest Ketamine Clinics. He has worked in healthcare for over 20 years and earned his Master’s degree and anesthesia training from Texas Wesleyan University in 2004. He is experienced in all types of anesthesia. He is passionate about providing the best patient experience for all patients AAS serves. He was voted top CRNA in Washington State 2013, 2018, 2019, 2020 and 2023. Allyn lives with his wife and children in Snoqualmie, Washington.