Regional anesthesia is becoming more used in total joint arthroplasty (TJA). It has demonstrated efficiency improvements by allowing patients to be processed in tandem in a dedicated block room (BR). However, there is no detailed measurement of these advantages to hospital operations. For a study, researchers sought to use detailed operational modeling to estimate the financial impact of creating a BR.
A discrete-event simulation model of daily OR patient flow for TJA surgeries in a medium-sized hospital was created. Two situations were tested: without and with a BR. Staffing needs, daily hours, and labor expenses were used to compare scenarios. The number of ORs and cases ranged from two to six, with each OR performing three to five cases. These findings were fed into a discounted cash flow (CF) model. The discounted CF model outputs were CF, net present value, internal rate of return, and return on investment.
The average time savings by integrating a BR were 68 minutes per day (range: 30 to 80 minutes per day), lowering the OR closing time by one hour. The incremental labor costs/day from nurse overtime compensation varied from $2,025 to $10,125 without a BR and from $1,595 to $9,045 with a BR, resulting in a $360 to $1,605 gain in profit/day. The annual cost of capital was $54,363, the net present value was $213,082, the internal rate of return was 12%, and the return on investment was 43.61%.
The analysis showed that a BR is more lucrative than no BR for a hospital executing TJA via a bundled care or private payer compensation model in all situations. Even after accounting for the initial financial investment, a BR was found to be a financially net positive. Furthermore, the work indicated the possibility of combining discrete-event simulation with financial analysis to evaluate alternative operational models of care, such as specialized trauma rooms and swing rooms, to increase hospital efficiency.