Call it the Goldilocks effect, the sweet spot, or simply a frontline KPI, but forecasting and maintaining optimal operating room utilization can make or break a health system’s bottom line. Keeping ORs in use – yet available for add-ons – is critical for revenue and satisfaction of surgeons and nursing staff. And yes, it matters for those efficiency metrics too.
You Can’t Afford a Haphazard Approach to OR Scheduling
Optimizing OR utilization is a balancing act that requires the ability to adjust quickly. Which means information and analytics are the engine that drive financial performance.
Let’s start with a primer on terms used to define these all-important metrics.
Operating room utilization is typically defined as the amount of time an OR is used for surgery, plus turnover time.
The rate of OR utilization is surgical hours, plus turnover hours, divided by the number of hours the staffed OR is available. (Utilization can also be calculated as raw utilization: the hours of cases divided by OR hours.)
Operating room turnover time (ToT), or turnaround time, encompasses the “total amount of time necessary to turn over the room from one patient to the next.”[1] This process involves every member of the perioperative team, including healthcare providers and environmental services, and it is a critical interval when it comes to efficiency.
Underutilization can be caused by staffing challenges, poor time allocation to surgeons, cancellations, inaccurate case duration forecasting, and more. Empty ORs are a lost opportunity – time and revenue that can’t be reclaimed. Optimizing the number of surgeries performed daily is a critical benchmark that supports the whole hospital’s economic growth.
Overutilization can lead to workflow breakdowns, delays, and cost overruns. It has the potential to create scheduling chaos that means patient and staff satisfaction can plummet. But there is a way to find a balance that keeps the plates spinning with expert precision.
Healthy Operating Room Utilization Goals
Working toward 100% utilization is not a healthy or desirable achievement. A full surgical schedule risks bottlenecks, long hours, and waiting patients.
Consider a first case delay on a day when every minute has been scheduled. The effects are quick and cascading, with patients waiting and staff working overtime. Satisfaction goes down and costs go up. Full utilization leaves no margin for anything outside what has been carefully planned. Real life just doesn’t work that way, and neither does OR scheduling.
In my experience, most institutions aim for 75% to 85% capacity. It’s been a standard target for some time, with variations for specialty, time of day, and other factors. To reach optimal capacity, your OR manager needs to know what is happening and have the ability to communicate quickly and accurately across the perioperative suite. Agility is key.
Timeliness is Necessary for Operating Room Analytics
Data doesn’t matter if you can’t trust it. That’s the message heard loud and clear from surgeons and nursing managers. Without confidence in the accuracy of data, it will not be actionable for change or improvement.
It’s best to get help from a team with prior experience getting perioperative data points out of EHRs. Some surgery-specific data elements are not stored as distinct items in existing recordkeeping systems, and have to be distilled with care from multiple sources. Otherwise, items like case duration may not translate out of the box into a consistent, analytics-ready structure that reflects how periop actually works. Distorted timing events or strange outliers can impact a team’s trust in advanced solutions, and whether or not the solution is actually adopted by OR stakeholders.
LiveData’s offering of next-day analytics and same-day real-time communication provides the transparency needed to see throughput bottlenecks, track cancellation causes, and assess usage data – clearly and accurately. You can access it quickly and know what happened the day before, informing today with the most actionable data. Engaging visual charts with adjustable filters can turn the ongoing challenge of OR utilization into opportunity, while turning your hospital’s top-level KPIs around.
To identify improvement opportunities that can enhance capacity efficiencies and drive surgical volumes, leadership must have up-to-date, reliable data. Schedulers and coordinators need at-a-glance access to identify open block times. Studies have found real benefits to examining OR performance metrics at a daily level to detect underlying patterns and understand variability.
Tough Questions You Need to Ask
What you don’t know about your OR utilization can hurt you, and it could be actively reducing your health system’s revenue. Where can you start? Ask the right questions:
- Are your First Case On-Time Starts (FCOTS) meeting benchmarks?
- How is OR usage distributed? Do you need to adjust block scheduling to attract and keep the surgeons you need?
- Are your perioperative suites over-scheduled, risking a house of cards collapse if variability in surgical or turnaround times or add-on cases are not considered?
- Is preop inefficiency driving high cancellation rates?
- Are operating rooms idle? If your ORs are underutilized, do you know why?
(If the answers come too late or not at all, your EHR might need a system of engagement.)
Open Scheduling vs. Block Time: What’s the Difference?
Block scheduling allocates blocks of time (often an 8-hour day) to a surgeon or group.
It has been likened to a restaurant reservation - surgeons can rely on the time to be available for their cases.
Agility Gives You the Edge
LiveData’s tools start with communication around the day of surgery. This strong start allows for real-time visibility, flexibility, and proactive adjustments that fill your rooms. It creates a culture of empowered managers - along with plugged-in charge nurses, anesthesia, and other frontline staff - which are essential to a smooth day. They’re all able to access agile, high-impact tools that can propel your health system forward.
Relying on clear, actionable findings is the easy way to understand what’s happening in the OR. And they’re a reliable way to ensure you’re consistently meeting OR utilization targets.
Sources (accessed January 2026):
- [1] Ambulatory Perioperative Services Wheels to Wheel https://www.jopan.org/article/S1089-9472(21)00223-9/abstract
- Improving operating room productivity and efficiency – are there any simple strategies? https://pmc.ncbi.nlm.nih.gov/articles/PMC5642860/
- Determining optimum operating room utilization https://pubmed.ncbi.nlm.nih.gov/12651670/
- Operating Room Utilization and Surgical Throughput Analysis https://umbrex.com/resources/industry-analyses/how-to-analyze-a-healthcare-provider/operating-room-utilization-and-surgical-throughput-analysis/
- Retrospective Analysis of Associated Costs and Sources of Variability in OR Utilization Across Weekdays http://doi.org/10.1002/aorn.14164
- A few simple rules for managing block time in the operating room https://www.ormanager.com/wp-content/uploads/pdfx/001/ORMVol20No11blockTime.pdf
- It Takes the Entire Team to Streamline Turnover Times https://www.aorn.org/outpatient-surgery/article/it-takes-the-entire-team-to-streamline-turnover-times
- Surgical pit crew: initiative to optimize measurement and accountability for operating room turnover time https://pubmed.ncbi.nlm.nih.gov/37451691/
- Increasing Operating Room Efficiency Through Decreased Turnover Times https://doi.org/10.46409/sr.NHNJ2929
- Operating Room Adjusted Utilization Study https://hse.eng.wayne.edu/Research/Wang-OR%20Utilization.pdf