


Critical Appraisal of a Research Study Sample Assignment

Sandbaek, B. E., Helgheim, B. I., Larsen, O. I., & Fasting, S. (2014). Impact of changed management policies on operating room efficiency. BMC Health Services Research, 14(1), 224. Doi: 10.1186/1472-6963-14-224

Background of the Study

The research in this study was centered on discovering how appropriate allocation of resources within a hospital could increase operating room efficiency. Specifically, the study focused on an intervention which included strategies like the redesign of how allocation was done (from mixed to dedicated resources), new policies regarding how patients were classified as urgent and policies on booking the OR for planned and unplanned surgeries. The importance of the study was established at the introductory comments where the authors made reference to the increased pressure on hospital resources and the corollary need to find more effective methods of allocating these limited resources for the overall good of the patients. In addition to effective allocation, the authors also referred to advanced planning and scheduling tools as components of interest in the quest for proper resource management. Essentially, the gap in knowledge is how the use of a multi-strategy intervention may impact on the efficiency of ORs. According to the authors, most recent studies merely focus on single-strategy changes like having one dedicated OR in every department for non-elective surgeries.

The purpose of the study, therefore, was to determine how multiple strategy interventions, including introducing the dedication of 3 ORs for non-elective procedures, new policies on pre-operative categorization, etc. could impact on efficiency. The research question that could be inferred from the study was how multiple strategy interventions influenced OR efficiency when compared to traditional single strategy interventions. This research question was, therefore, related to the problem.

Method of Study

Qualitative methods would not be favorable to the research study because they would not assist the authors in making a determination of whether or not the intervention strategies were effective. Unlike qualitative research which merely provides a useful groundwork for the potential quantitative research, quantitative research is valuable in quantifying the problem and generating usable statistics. In this study, the authors identified a particular perspective from which to carry out the research. They selected a publicly-financed tertiary referral hospital as their center of research. In this regard, they used the hospitals ORs to test the effectiveness of their intervention strategies.

Furthermore, the authors cited other studies which were relevant to the focus of their research. For example, they mentioned the research study by Heng and Wright (2013) which was the most recent study relative to their research and which had considered both the elective and non-elective patients when exploring how the dedication of specific ORs for emergency operations helps to improve the efficiency and access to healthcare. Also, they cited a qualitative study which was carried out by Fitzgerald et al. (2006) which aimed to evaluate how different healthcare providers rated the urgency of a particular set of clinical conditions. All the references that were used by the authors were current as all of them were dated at most ten years from the time of the authors' research study. Also, the older references were mostly qualitative studies which were still useful and applicable to their research.

However, the authors also indicated the weaknesses of the studies which they made reference to. For instance, the authors mentioned that the significant shortfall of most of the studies that they referred to was that they only employed single strategies in their interventions thus establishing a gap in the literature on studies which have focused on how a multi-pronged intervention could affect the efficiency of ORs. What is more, the authors also noted the fact that although the concept of standardization of clinical prioritization had been discussed in the various literature, no research had been carried out on this matter.

Even though the literature review was not lengthy, it was relevant and thus adequate for building a logical argument for the research study. Furthermore, the authors took a direct and succinct approach to explaining how the current literature had not adequately addressed the focus of their research study. Therefore, their research was not bogged down by unnecessary and lengthy discussions but rather, went directly to the literature that was appropriate for establishing a justification for their study. No framework, however, was developed from the findings of the study.

Results of the Study

The result of the intervention measures was that there was a more efficient and cost-effective use of ORs. Despite the fact that the number of ORs which were dedicated to elective patients was reduced, the staff was able to handle a slightly higher amount of elective case time. There was also no record of delayed surgeries or recorded delays of elective procedures. For the non-elective cases, there was also documented improvement in efficiency. However, the authors noted that the findings could have been explained from different fronts i.e. they could have been as a result of the new patient classification system or the dedication of more ORs to non-elective surgery. On the whole, the results showed that more efficient use of ORs was both cost-effective and it led to the satisfaction of both the patients and the staff. Specifically, the patients were not subjected to delays, and the staff was able to work in a more relaxed atmosphere because surgeries did not have to be performed under pressure.

Ethical Considerations

There was no consent from any institutional review boards. However, the authors noted that they did not have any competing interests concerning the research study. Also, they maintained the confidentiality of all the staff members and patients who participated in the study. The research findings were presented in the form of statistics, and the ambiguity of the participants was well preserved. As the intervention methods were related to administrative functions, the consent of the patients was not required since the intervention did not necessarily introduce any new treatment.


In sum, appropriate allocation of resources within a hospital does result in increased efficiency. The research study revealed that if resources were allocated appropriately and expertly, the staff could find that they even have additional time and resources to spare. Also, it was made apparent that efficiency can, in fact, solve some of the other challenges which are faced by healthcare staff. For instance, if efficiency is improved in ORs, the experienced staff will have more time to dedicate to the training and instruction of residents, and this would inevitably translate to enhance the quality of care. Also, patient satisfaction would improve because patients do not have to go through the frustrating experience of having their surgical procedures postponed. Lastly, efficiency also meant that the physicians and nurses did not have to operate in an environment of pressure and stress. Therefore, efficiency is not only necessary for securing the health of the patients, but rather, it also plays a role in ensuring the wellness of the staff who provide healthcare.


Fitzgerald, J., Lum, M., & Dadich, A. (2006). Scheduling unplanned surgery: a tool for improving dialogue about queue position on emergency theatre lists. Australian Health Review, 30, 219-231.

Heng, M., & Wright, J. G. (2013). Dedicated operating room for emergency surgery improves access and efficiency. Canadian Journal of Surgery, 56, 167-174.


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