RT Journal Article SR Electronic T1 Evaluation of a tiered operating room strategy at an academic centre: comparing high-efficiency and conventional operating rooms JF Canadian Journal of Surgery JO CAN J SURG FD Canadian Medical Association SP E739 OP E748 DO 10.1503/cjs.004021 VO 65 IS 6 A1 Moaz Chohan A1 Aurelia Bihari A1 Christina Tieszer A1 Melanie MacNevin A1 Cheryl Churcher A1 Cathy Vandersluis A1 Florence Cassar A1 Cheng Lin A1 Emil Schemitsch A1 David Sanders A1 Abdel-Rahman Lawendy YR 2022 UL http://canjsurg.ca/content/65/6/E739.abstract AB Background: Wait times for many elective orthopedic surgical procedures in Ontario have become unacceptably long and substantially exceed the recommended guidelines. As a consequence, many patients experience chronic pain, disability and other poor health outcomes. The purpose of this study was to test a novel, resource-saving redesign of outpatient operating room (OR) services, based on tiered grouping of surgical cases, to maximize health benefits for patients while improving efficiency and decreasing wait times.Methods: This prospective cohort study enrolled adult patients scheduled to undergo unilateral lower limb procedures that had a low requirement for surgical resources and did not require admission to the hospital (ambulatory surgical services) at an academic hospital. Patients were randomly assigned to a conventional OR group or a high-efficiency (tiered) OR group, in which the intensity of surgical, anesthesia and nursing resources was matched to the procedure and the patient’s health status. The tiered OR made use of local anesthesia and a block room rather than general anesthesia. Primary outcomes were costs of surgical services provided and patient health outcomes; secondary outcomes were patient and staff satisfaction with each OR setup.Results: The costs associated with the high-efficiency OR were 60% lower than those associated with the conventional OR (this was primarily due to the streamlining of OR care and elimination of the need to use a postanesthetic care unit), with the same or equivalent patient health outcomes. No differences in patient and staff satisfaction were found between the 2 setups.Conclusion: The use of tiered, ambulatory services for elective orthopedic surgery does not compromise health outcomes and patient satisfaction, and it is associated with substantial cost savings.