A “flip room” assigns one surgeon to two adjacent ORs with two full OR teams. While one case is finishing in Room A(closing, emergence, cleaning), the next patient is induced and prepped in Room B. The surgeon “flips” between rooms so knife-to-skin time is maximized for that surgeon.
FROM THE FACILITIES PERSPECTIVE, EACH MINUTE OF UTILIZATION IN THE OR IS EXPENSIVE.
A variety of cited analysis of hospital cost reports estimates the mean cost of OR time is $36–$37 per minute, which includes all direct and indirect costs. Still other studies have put the cost much higher, in the $46 to $60 per-minute range.
Surgeons are proponents of flip rooms and, in theory, flip rooms should improve efficiency and profitability. For example, assuming room turnover time is 20 minutes per case at $37/min, 20 minutes saved is $840 of OR time for each case.
The goal of many facilities is to achieve combined OR utilization rates greater than 60% in order to meet the clinical needs and financial targets of the facility. This requires OR capacity be backfilled with more OR cases, requiring effective scheduling and planning.
WHY ADMINISTRATORS LIKE FLIP ROOMS
Surgeons are among the highest revenue generators in hospitals. Flip rooms reduce surgeon downtime and allow more cases per day, which translates into higher throughput and financial returns. This, coupled with reduced downtime of idle ORs, saves significant OR operating costs. Many health systems are under pressure to shorten wait time, and flip rooms are appealing in that they aid in reducing surgical backlogs, expand patient access and meet volume targets.
In addition to the direct financial incentives, hospital administrators benefit by offering efficient schedules that attract and retain busy, high-volume surgeons. Hospitals can market this efficiency as a perk, strengthening their reputation in competitive markets. Since orthopedic cases are often major utilizers of flip rooms, recruiting and retaining orthopedic surgeons is a high priority to most health systems. For example, a 2019 survey published by Merritt Hawkins estimated that the average orthopedic surgeon generates $3.3 million in hospital revenue annually. If a health system can recruit and retain a robust orthopedic team of surgeons the profitability of the hospital increases significantly.
WHY ANESTHESIOLOGISTS DO NOT LIKE FLIP ROOMS
Unlike surgeons, anesthesiologists do not have a main task in surgery, and they remain responsible until emergence, transfer and recovery are complete. With flip rooms, they’re often pulled between induction in one OR and emergence in another, creating unsafe overlaps. Anesthesia requires constant vigilance, and rushing to complete preop assessments or dividing attention between rooms increases the risk of missed complications during induction or emergence, which are two of the most critical phases of anesthesia care. Since anesthesia care is continuous, flip rooms often ignore this reality, prioritizing surgical efficiency over anesthesia safety and workflow. This mismatch creates tension between surgical and anesthesia teams.
From a documentation prospective, anesthesiologists must complete real-time, detailed records; and managing two rooms raises the risk of delayed or incomplete documentation, which can impact compliance, billing and medicolegal safety. Since anesthesia is already a cognitively demanding specialty, flip rooms eliminate natural pauses, heighten pressure and increase fatigue, which may contribute to burnout and reduced job satisfaction.
Case Example:
Facility: Community hospital orthopedic service. Busy arthroplasty surgeon requests a flip room. The surgeon expects to complete 12 cases by noon.
Setup: Two ORs, two anesthesia providers.
Metrics to evaluate:
- Additional anesthesia hours: If the second operating room is utilized sporadically, care team productivity (ASA units per provider day) is negatively impacted.
- When the second room is less productive, the costs of anesthesia care are greater than revenues, which becomes financially challenging for the anesthesia department.
- If combined utilization slips to 50%, the hospital ties up two rooms to get the output of one, while anesthesia schedules two providers to provide coverage. Since staffing costs of anesthesia providers continue to soar due to a national anesthesia staffing shortage, underutilized anesthesia providers become a loss to the group and the health system since many departments are subsidized.
WHAT’S THE SOLUTION?
Ultimately, sustainable efficiency requires collaborative solutions developed by anesthesia clinicians and hospital administration. Regular meetings need to be scheduled with robust OR efficiency reporting, the evaluation of case scheduling backlogs and the budget impact of each flip room strategy.
Some collaborative strategies may include the following:
- Dedicated anesthesia teams: Assigning two anesthesia providers (e.g., anesthesiologist and CRNA) to each flip room to ensure safe coverage of both induction and emergence.
- Anesthesia tech and PACU support: Expanding the role of anesthesia technicians or PACU staff can reduce the workload of anesthesiologists during turnovers.
- Smart scheduling: Limiting flip rooms to certain types of procedures (e.g., shorter, lower-risk surgeries) may reduce safety risks.
- Cross-disciplinary planning: Involving anesthesiologists in OR efficiency planning ensures their concerns are factored into scheduling decisions.
CONCLUSION
Flip rooms illustrate the ongoing tension between efficiency and safety in healthcare. For administrators, they promise improved throughput, higher revenue and happier surgeons. For anesthesiologists, they pose risks of overload, compromised vigilance and burnout.
The truth lies somewhere in between: while flip rooms can improve numbers on paper, they must be implemented with careful consideration of staffing, safety and the realities of anesthesia care. Hospitals that prioritize short-term efficiency over long-term team sustainability risk alienating critical staff and, more importantly, compromising patient safety.
Gary Keeling, CPA, MBA, serves as Vice President Anesthesia RCM for Coronis Health. Keeling has 31 years’ experience in healthcare management, 28 of it devoted to anesthesia practice management and consulting. During that time, he has worked with over 90 anesthesia groups and provided ongoing practice management services and financial management services for clients throughout the US. Other duties include financial feasibility analyses, subsidy needs analysis, payer contracting, including carveouts, revenue projections and the development of chronic pain centers, as well as flat fee anesthesia rate bundled payment reimbursements. Keeling is a certified public accountant (CPA) and has an MBA with a concentration in finance. He can be reached at gary.keeling@coronishealth.com.