O.R. efficiency is a growing field challenging the traditional philosophical separation between medicine and business. Process improvement strategies, such as Six Sigma and Toyota’s Lean Production System, are widely promoted for efficiency and cost savings. When efficiency and quality become unbalanced, however, patient safety implications can ensue.

Improving O.R. efficiency is an attempt to provide quality health care in a cost-conscious manner. O.R. efficiency can be measured in various ways: turnover time, case cancellation rates, start time tardiness, contribution margin, prediction bias of case duration, PACU admission delays and staffing costs. Health care costs have skyrocketed throughout the years with $2.9 trillion being spent and consuming 17.2 percent of the gross domestic product in 2013. Nationally, there has been a big push to control perioperative expenses without compromising patient safety.

Many attempts to improve efficiency have been successful. Parallel processing has been found to improve turnover time from...

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