An idea to streamline the operating room got patients into surgery sooner

When a surgeon saw patients stuck waiting for orthopedic surgeries, he designed a better operating room that's publicly funded to do the procedures faster and more efficiently. It's a model other hospitals are interested in copying.

Pandemic worsened wait lists for non-urgent surgeries. A London hospital models an alternative

A woman wearing a hospital gown lies in a bed with crutches and a monitor by her side.
Since Mary Curry's pain was not life-threatening, she likely would've had to wait longer for the surgery to resume walking on her heel without Dr. Abdel-Rahman Lawendy's OR innovation. (CBC)

When a surgeon saw patients stuck waiting for orthopedic surgeries, he designed a better operating room — one that's publicly funded and can do the procedures faster and more efficiently. 

Now, it's a model other hospitals are interested in copying.

Dr. Abdel-Rahman Lawendy, chief and medical director of the ambulatory surgical centre at London Health Sciences Centre, reimagined the OR — one of the most resource-intensive places in a hospital — for select orthopedic surgeries.

His "Surgi-centre" idea takes certain patients away from the large, standard operating rooms full of staff and equipment, paring that down to just what is needed to operate on ambulatory patients — people who can walk after surgery and go home the same day. An example of the surgeries performed include repairing a torn ACL in the knee, a common sports injury. And the surgeries are done at ORs outside of the hospital, though they're managed by the institution.

In comparison, standard hospital operating rooms need to be prepared for complex surgeries that require about six staff per room and a full set of sterilized instruments, just in case they're needed.

"By cutting all of that stuff out, you essentially drive the cost down significantly and then increase the efficiency, which in our system doesn't necessarily translate to saving more money," Lawendy said. "It translates into treating more patients."

Surgeon leaning in OR.
Dr. Abdel-Rahman Lawendy found ways to cut costs of certain surgeries while maintaining quality. (Turgut Yeter/CBC)

Treating more patients is particularly important now as the COVID-19 pandemic lengthened an already long wait-list for non-urgent surgeries, hospital officials say.

The average wait time in Canada last year for hip replacements was about 25 weeks, according to the Canadian Institute of Health Information

But Mary Curry waited only 14 weeks for a forefoot reconstruction. Arthritis had already resulted in months of foot pain that limited the Denfield, Ont., patient's mobility and left her psychologically exhausted.

Strong team adds to efficiencies

Since Curry's pain was not life-threatening, without Lawendy's innovation, she likely would've had to wait longer for the surgery to resume walking on her heel, given the average wait times.

Patients qualify for the ambulatory surgery option at the London hospital's Nazem Kadri Surgical Centre if they're relatively healthy and are having minor foot, ankle or hernia surgeries that require minimal equipment.

Woman standing in OR.
Jillian Holbrough, the centre's clinical manager, initially hesitated at the idea of a stripped-down operating room. Then, she says she and the rest of the team got on board. (Turgut Yeter/CBC)

"The crew was amazing," Curry said as she was wheeled out of the smaller, high-efficiency OR. "Stayed awake until I started feeling the pushing and pulling."

Jillian Holbrough, the surgical centre's clinical manager, said staff are at least 30 per cent faster than in the hospital's standard ORs. They perform between 10 and 15 surgeries a day in two operating rooms. "It was a bit frightening at first, the thought, because it was so innovative," Holbrough said of the initial hesitation.

Then the culture changed and staff came on board.

"We have a very strong team here and we all work together," said Holbrough, who is also the manager at  Victoria Hospital's OR, also in London, Ont. "And that, in and of itself, creates a lot of efficiencies."

Same quality, lower cost

Holbrough said the ambulatory centre also offers a great patient experience since people receive care before and after the surgery at the same spot by the same nurse.

Lawendy's graduate student, Moaz Bin Yunus Chohan, wrote a thesis about the Surgi-centre based on data testing the approach in more than 1,000 patients.

Instead of the standard minimum of six staff in the OR, the smaller operating theatres have exactly what's needed for that particular patient — be it surgical, anesthesia and nursing personnel and equipment, Lawendy said.

"Essentially it demonstrates that we can cut costs while maintaining quality," said Lawendy, who is also chief of the orthopedic trauma service.

WATCH | London hospital models an OR with reduced waits for surgeries: 

High-efficiency operating rooms show promise for cutting wait times

11 months ago
Duration 5:32
An Ontario doctor has tested his plan for streamlined surgery centres that treat more patients in less time, all in the public health system. Now, it’s a model other hospitals are hoping to duplicate.

The researchers found that costs in the conventional or hospital operating rooms ran about $469 per patient.

In the high-efficiency or ambulatory centre, the cost fell to $172 per patient. And patients treated in regulated ambulatory centres also tend to have fewer post-surgery complications, which results in further cost-savings.

The Ontario government is looking at Lawendy's public system model as a way to safely speed up surgeries.

"We have people coming to tour here nearly every week to see what the model is like from all over Ontario," he said.

Dr. Danny Goel, a clinical professor in orthopedic surgery at the University of British Columbia, is not involved in Lawendy's model, which he called a major shift.

"As more procedures are shifting to this method-of-care delivery, the opportunity to invest in surgical centres should be strongly encouraged to decrease the burden on a traditional hospital setting," Goel said in an email.

"While there may be some initial infrastructure and implementation challenges, the long-term benefits to patient care and the Canadian health-care system in general would be significant."

For its part, London Health Sciences Centre plans to scale up to four more ambulatory ORs.

With files from CBC's Marcy Cuttler