{
  "abstract": "In modern hospitals, the operating room (OR) represents one of the most cost-intensive areas, with an estimated average cost ranging between $30 to $100 per minute, depending on the local context and resource configuration. These costs are predominantly fixed: salaries of surgical and nursing staff, infrastructure maintenance, equipment depreciation, and general overheads do not vary with the number of procedures performed. In contrast, variable costs (such as drugs, surgical disposables, and anesthesia gases) are relatively marginal in this context. This cost structure implies that the true economic challenge in surgical services is not cost reduction per se, but optimization of time, the OR’s most valuable and scarce asset. From a microeconomic standpoint, improving the throughput of surgical programs —i.e., the number of surgeries performed in a fixed time window— is the key to maximizing value. One of the most effective levers is the reduction of changeover times between procedures. In this regard, the SMED (Single-Minute Exchange of Die) methodology, borrowed from industrial Lean Management, provides a structured approach to compress turnover times. SMED encourages the separation of internal (must be done when the OR is vacant) and external (can be done in parallel while the OR is in use) setup tasks, standardization of instrument trays, and enhanced role coordination among staff. When systematically applied, SMED can reduce changeover time by over 50%, enabling either more procedures per day or earlier finishes without compromising safety. Another often underutilized strategy involves bypassing the Post-Anesthesia Care Unit (PACU). For selected patient populations (typically those undergoing short, low-risk procedures with fast-acting anesthetic agents or regional anesthesia) direct transfer to the ward postoperatively may be safe and appropriate. Although this does not necessarily generate large direct savings (PACU time per se is not a major cost driver), it prevents PACU bottlenecks, which are a common cause of OR delays. Since every minute of OR idle time carries a high fixed cost, avoiding PACU-induced disruptions yields significant indirect economic benefits. The saving is therefore calculated not by subtracting PACU costs, but by valuing OR time not wasted, typically quantified in terms of minutes preserved times cost per minute. These strategies underscore a crucial paradigm: OR efficiency is less about reducing costs and more about enhancing value from fixed investments. The application of Lean principles, microeconomic logic, and patient-centered clinical criteria can together reshape surgical workflows. Ultimately, optimizing OR time not only benefits institutional sustainability and patient access, it also releases pressure, carving out a little time for what every anesthesiologist deserves: a little time to enjoy a coffee.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland"
      ],
      "name": "Andrea Saporito"
    }
  ],
  "title": "FT46 Freakonomics: optimize OR to have time for a coffee",
  "uid": "c8eddb4e-498a-59c5-96bb-7ac5b27dcb0b"
}