OR and OR/ASC Optimization:
SBAR, 5 Successful Case Studies and Project Plan
Date: November 12, 2025
S — Situation
Hospitals and ASCs face persistent perioperative bottlenecks—late first-case starts, long turnover times, and under-utilized blocks—squeezing margins just as labor and drug costs rise; CMS payment updates for CY 2026 (OPPS/ASC, PFS) add urgency to hardening OR throughput and access. https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-and-ambulatory-surgical
B — Background
Over the past decade, ORs became the economic engine for many systems, but process variation (pre-op readiness, surgeon punctuality, anesthesia staffing, room turnover, case add-on rules) eroded productivity. Recent literature and multi-center reviews identify two levers with the greatest ROI: (1) first-case on-time starts (FCOTS) and (2) turnover time discipline, embedded in block management and PSH-style coordination. https://pubmed.ncbi.nlm.nih.gov/40054053/
https://pmc.ncbi.nlm.nih.gov/articles/PMC11703430/
A — Action
Leaders are instituting Lean/Six Sigma FCOTS playbooks, enforcing real-time turnover standards, tightening block governance, and building PSH/clinical pathways to smooth perioperative flow—aligned with 2026 policy shifts in site-of-service and payer structures.
https://aornjournal.onlinelibrary.wiley.com/doi/abs/10.1002/aorn.14381
https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc
R — Results: Five Case Studies
1) Mid-Atlantic ASC — FCOTS from 30% → 79% in 12 months. Lean Six Sigma with time-based nurse pre-op targets raised first-case on-time starts to 79%. https://www.aorn.org/article/reducing-first-case-start-time-delays
2) Academic L&D ORs — Targeted barrier removal reduced first-case delays after standardized checklists and paging. https://gocm.bmj.com/content/5/4/e000083
3) Tertiary OR (Puerto Rico) — Turnover bottlenecks identified and cut through sequencing and staffing fixes. https://www.sciencedirect.com/science/article/abs/pii/S2405603025000408
4) Orthopedic ASCs — Block governance and readiness improved throughput and reduced overtime exposure. https://www.hstpathways.com/blog/maximizing-or-utilization-in-ortho-ascs/
5) Endoscopy OR/ASC — Standardized pathways boosted turnover and scheduling reliability. https://www.asge.org/home/resources/key-resources/blog/view/practical-solutions/2025/08/07/optimizing-endoscopy-efficiency-across-settings--practical-lessons-from-ascs-and-hospitals
Quality Metrics From These Case Studies
1) FCOTS uplift: +30–50 percentage points within 6–12 months. https://www.aorn.org/article/reducing-first-case-start-time-delays
https://gocm.bmj.com/content/5/4/e000083
2) Turnover: 5–10 minutes saved per room turn via clearer workflows. https://pubmed.ncbi.nlm.nih.gov/40054053/
https://www.sciencedirect.com/science/article/abs/pii/S2405603025000408
3) Block utilization: Achieving 85% utilization boosts cases/day, reduces overtime. https://www.hstpathways.com/blog/maximizing-or-utilization-in-ortho-ascs/
4) Endoscopy turnover: >15% idle-time reduction post-standardization. https://www.asge.org/home/resources/key-resources/blog/view/practical-solutions/2025/08/07/optimizing-endoscopy-efficiency-across-settings--practical-lessons-from-ascs-and-hospitals
5) Financial: Each 5-minute turnover reduction can unlock one add-on case/day. https://pubmed.ncbi.nlm.nih.gov/40054053/
6) Policy: Align block governance with 2026 OPPS/ASC and PFS changes. https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-and-ambulatory-surgical
https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc
7) PSH linkage: Integrated pathways shorten LOS and reduce bottlenecks. https://www.asahq.org/psh
Leadership Project Plan — 'OR/ASC Optimization SBAR Sprint'
Week 1 (Nov 17–23): Discover & Baseline — Form periop steering group, set metrics (FCOTS %, turnover min, utilization %), pull 90-day baseline, confirm CY2026 OPPS/ASC context. https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-and-ambulatory-surgical
Week 2 (Nov 24–30): Design FCOTS Playbook — Implement time-based pre-op targets, surgeon punctuality standards, and turnover standard work. https://aornjournal.onlinelibrary.wiley.com/doi/abs/10.1002/aorn.14381
Week 3 (Dec 1–7): Block Governance — Set 85% block-utilization target, automate release at T-14, post open-time rules. https://www.hstpathways.com/blog/maximizing-or-utilization-in-ortho-ascs/
Week 4 (Dec 8–14): PSH & Post-op Flow — Launch PSH workstream linking pre-, intra-, and post-op phases. https://www.asahq.org/psh
Week 5–6 (Dec 15–28): Scale & Sustain — Extend FCOTS playbook, kaizen reviews, surgeon dashboards, exec scorecard reporting.
National Daily Hospital News
📍 Published at National Daily Hospital News
#HospitalOps #CMS #HealthcareWorkforce #HospitalFinance #EmergencyServices #HospitalLeader #NursingExecutive #NursingLeader #EmergencyPhysician #Nursing #Hospitals #CaseManagement #EmergencyNurse
Published as part of the National Daily Hospital News series.
Visit the archive here: https://nationaldailyhospital.blogspot.com/
Connect with us:
LinkedIn: https://www.linkedin.com/in/spencetepper/
Facebook: https://www.facebook.com/Compirion
Number One Hospital Blog: https://bethenumber1hospital.blogspot.com/
© 2025 National Daily Hospital News
Principle Author: ChatGPT5
Editor: Spence Tepper
Permission to share freely given
No comments:
Post a Comment