A Strategy You Can Flip For? Adding Capacity Through OR Flip Rooms

Adding flip rooms to your OR might not change the world, but it could change your productivity.

Take the example of smartphones - so ubiquitous that it’s hard to imagine life without their instant, portable connection. It took a fresh look at an old idea to free phones – and their owners – from a landline. Famously, engineer Martin Cooper thought outside the traditional box, understanding that “people want to talk to other people – not a house, or an office, or a car” and a phone number should be associated with a person to make that possible. 

“Flip rooms” might be the operating room equivalent to that first location-free device – moving a surgeon between two rooms, two patients, and two teams – creating a strategy that can reduce turnover time and maximize prime time utilization.

Without a flip room, your OR management strategy might be missing a key tool that can increase efficiency and decrease patient wait times. Implementing this strategy requires the right tools for a full understanding of your OR’s time use, benchmarks, and bottlenecks.

Clear Benefits from Flip Rooms

The benefits of flip rooms include maximizing surgeons’ time, which in no small measure can be a strategic use of resources to attract and retain talent. With a flip room approach, surgeons are present during critical portions of procedures, when their expertise is needed, and they are not idling during turnover time.

Studies indicate that staggered or overlapping surgeries with a flip room is a safe strategy that can allow for a significant increase in cases. 

How can using twice the space be efficient? It comes down to optimizing resources and processes.

What’s Needed to Implement a Flip Room

OR and perioperative suite capacity and staffing are frontline considerations when developing a flip room strategy. Without a second team to staff it, the flip room can easily become wasted space. Surgeons will continue to wait, and that key FCOTS benchmark gets lost to a cascade of bottlenecks, which may be unknown or misunderstood if analyzed with stale data.

Adequate staffing for each room and the consideration of care team needs should be a factor, along with surgeon productivity and the type of care provided.

Without a solid understanding of your OR capacity, adding a flip room can be a burden to OR managers and staff. Team buy-in through clear workflow parameters, fast response to challenges, and efforts to prevent scheduling breakdowns can make the difference in a flip room’s success.

Ask yourself, are procedure lengths accurately estimated and predictable? Is volume understood and allocable? Everyone from preop to environmental services will need to be invested in collaborating on flip rooms. 

In addition, creating team consistency can be a factor in establishing a work environment that benefits overall productivity.

Once capacity has been established, clear use policies are needed to maintain efficiency and optimize OR time. If a surgeon is not a good flip room candidate - “don't let this doc flip!" 

Flip rooms are generally liked by individual surgeons, whether or not they make sense for ORs. But flip cases should be like puzzle pieces fitting together, where closing to incision is about the same length from incision to closing of the next case. Nurses need to check for issues, like whether a surgeon’s cases take too long; or confirming that flip rooms meet KPIs under a certain surgeon.

Prime Time Hours Make or Break a Flip Room Schedule

There’s a dangerous assumption behind many flip room strategies: more rooms = more throughput. That isn't always the case.

Proactive attention to creating an agile, efficient environment can ensure that an additional OR doesn’t become a waiting room – patients waiting, team members waiting, and revenue lost. 

In some cases flip rooms can backfire by decreasing overall utilization for the day, especially if there is a surfeit of surgeons and cases.

Each empty but idle operating room can cost up to $1,000 per hour. And depending on the facilities and/or subspecialist procedures, even a single minute of OR downtime can present an opportunity cost of up to $100. 

If flip rooms are poorly executed, you don’t just fail to gain efficiency—you:

• Reduce total utilization
• Increase labor strain
• Create scheduling instability
• lose the ability to run an additional fully productive room

In other words, you trade controlled inefficiency for chaotic inefficiency.

Allocating an expensive OR efficiently, whether through a traditional approach or a flip room, means understanding and increasing prime time utilization by spotting problems and delays while they are still actionable.

A flip room approach is not a one-size-fits-all proposition. Adopting it requires thought, planning, and a timely look at data that accounts for the nuances of scheduling needs. With or without flip rooms, understanding workflow in the perioperative suite is an operational imperative for minimizing turnover time and increasing efficiency.

Additional References:

• https://catalyst.nejm.org/doi/pdf/10.1056/CAT.22.0244
• https://www.anesthesiallc.com/publications/anesthesia-provider-news-ealerts/1270-flip-rooms-impact-on-anesthesia-staffing
• https://www.canjsurg.ca/content/53/3/167
• https://pmc.ncbi.nlm.nih.gov/articles/PMC3728239/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC10351225/
• https://periopconsult.com/blog/f/to-flip-or-not-to-flip-that-is-the-question
• https://www.ormanager.com/policy-compliance-essential-overlapping-surgery-safety/
• https://www.sciencedirect.com/science/article/abs/pii/S0883540320300991
• https://www.utoledo.edu/policies/utmc/administrative/pdfs/3364-100-53-27.pdf