Optimizing Surgical Access for Patients: A Systematic Review of Operating Room Coordination Strategies

Talal A. Al-Zaharani¹, Nahed G. Aldossary² and Maryam A. Alkhalaf^3,

¹OR and Ambulatory Director, Security Forces Hospital, Dammam, Saudi Arabia M.sc Science in Healthcare Management

²Group Director of Nursing EHC, Saudi Arabia M.sc Science in Healthcare Management

³Group Supervisor of Nursing research and evidence-based EHC, Saudi Arabia MSc in Health Research and Social science

Cite this paper:
Talal A. Al-Zaharani, Nahed G. Aldossary and Maryam A. Alkhalaf. Optimizing Surgical Access for Patients: A Systematic Review of Operating Room Coordination Strategies. American Journal of Nursing Research. 2026; 14(2):37-43. doi: 10.12691/ajnr-14-2-3

Abstract

Background: Timely access to surgical care remains a global challenge. Inefficient operating rooms (ORs) result in prolonged wait times, cancellations, and wasted resources. This study highlights effective strategies to optimize OR coordination. Methods: A systematic review was conducted following PRISMA guidelines. Five databases—PubMed, Scopus, Web of Science, Cochrane Library, and CINAHL—were searched for English-language studies published between 2013 and 2025, including key earlier works. Results: The studies included (n = 34) were grouped into a few main themes related to improving the operating room. Six studies focused on scheduling and planning strategies, including models for resource allocation and optimization. Five studies examined workforce-related factors, including staffing levels, workload, and nursing competencies, while an additional five studies focused on coordination and communication within surgical teams. Four studies examined digital and AI-driven methods, which are a growing yet still emerging field. Three studies examined lean and process improvement methods. The remaining studies (n = 11) examined broader issues, including patient safety, surgical outcomes, and organizational performance. Conclusion: Strategies to coordinate ORs can increase efficiency and access. However, no single approach is universally effective. For Saudi hospitals, a customized model incorporating Lean principles, digital innovations, extended hours, and team engagement is most promising. Recommendations: Policymakers are encouraged to consider standardizing operating room performance metrics across hospitals and piloting extended evening and weekend operating lists at tertiary centers to maximize capacity and access. These efforts could be supported by routine monitoring, expanded Lean training programs for sustained improvement, and decisive investment in integrated digital and AI-driven scheduling tools aligned with Saudi Vision 2030.

Keywords:
Operating room surgical access Coordination Utilisation Scheduling

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Oliveira, M., et al. (2023). A systematic literature review on the utilization of extended operating room hours. Frontiers in Public Health, 11, 1118072.
[2]	Eastern Health Cluster. (2024). Operating room optimisation project report (Unpublished internal document).
[3]	Cima, R. R., Brown, M. J., Hebl, J. R., Moore, R., Rogers, J. C., Kollengode, A., Amstutz, G. J., Weisbrod, C. A., Narr, B. J., & Deschamps, C. (2011). Use of lean and Six Sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center. Journal of the American College of Surgeons, 213(1), 83–92.
[4]	Merghani, A. M. A., Esmail, A. K. A., Osman, A. M. E. M., Mohamed, N. A. A., Shentour, S. M. M. A., & Merghani, S. M. A. (2025). The role of machine learning in management of operating rooms: A systematic review. Cureus.
[5]	Schouten, A. M., Flipse, S. M., Van Nieuwenhuizen, K. E., Jansen, F. W., Van Der Eijk, A. C., & Van Den Dobbelsteen, J. J. (2023). Operating room performance optimization metrics: A systematic review. Journal of Medical Systems, 47(1).
[6]	Bergs, J., Hellings, J., Cleemput, I., Zurel, Ö., De Troyer, V., Van Hiel, M., Demeere, J., Claeys, D., & Vandijck, D. (2014). Systematic review and meta-analysis of the effect of the World Health Organization surgical safety checklist on postoperative complications. British Journal of Surgery, 101(3), 150–158.
[7]	Bracken, A., Reilly, C., Feeley, A., Sheehan, E., Merghani, K., & Feeley, I. (2025). Artificial intelligence (AI)-powered documentation systems in healthcare: A systematic review. Journal of Medical Systems, 49(1).
[8]	Brown, C., Hofer, T., Johal, A., Thomson, R., Nicholl, J., Franklin, B. D., & Lilford, R. J. (2008). An epistemology of patient safety research: A framework for study design and interpretation. Part 1: Conceptualising and developing interventions. BMJ Quality & Safety, 17(3), 158–162.
[9]	Calegari, R., Fogliatto, F. S., Lucini, F. R., Anzanello, M. J., & Schaan, B. D. (2020). Surgery scheduling heuristic considering OR downstream and upstream facilities and resources. BMC Health Services Research, 20(1).
[10]	Cappanera, P., Lapucci, M., Schoen, F., Sciandrone, M., Tardella, F., & Visintin, F. (2023). Optimization and decision science: Operations research, inclusion and equity. Springer Nature.
[11]	Cheng, H., Clymer, J. W., Chen, B. P., Sadeghirad, B., Ferko, N. C., Cameron, C. G., & Hinoul, P. (2018). Prolonged operative duration is associated with complications: A systematic review and meta-analysis. Journal of Surgical Research, 229, 134–144.
[12]	Gillespie, B. M., Polit, D. F., Hamlin, L., & Chaboyer, W. (2011). Developing a model of competence in the operating theatre: Psychometric validation of the Perceived Perioperative Competence Scale-Revised. International Journal of Nursing Studies, 49(1), 90–101.
[13]	Hassanain, M., Zamakhshary, M., Farhat, G., & Al-Badr, A. (2016). Use of Lean methodology to improve operating room efficiency in hospitals across the Kingdom of Saudi Arabia. The International Journal of Health Planning and Management, 32(2), 133–146.
[14]	Kc, D. S., & Terwiesch, C. (2009). Impact of workload on service time and patient safety: An econometric analysis of hospital operations. Management Science, 55(9), 1486–1498.
[15]	Kiekkas, P., Tsekoura, V., Aretha, D., Samios, A., Konstantinou, E., Igoumenidis, M., Stefanopoulos, N., & Fligou, F. (2019). Nurse understaffing is associated with adverse events in post-anaesthesia care unit patients. Journal of Clinical Nursing, 28(11–12), 2245–2252.
[16]	Levine, W. C., & Dunn, P. F. (2015). Optimizing operating room scheduling. Anesthesiology Clinics, 33(4), 697–711.
[17]	Lingard, L. (2004). Communication failures in the operating room: An observational classification of recurrent types and effects. BMJ Quality & Safety, 13(5), 330–334.
[18]	Lingard, L., Regehr, G., Espin, S., & Whyte, S. (2006). A theory-based instrument to evaluate team communication in the operating room. BMJ Quality & Safety, 15(6), 422–426.
[19]	May, S. M., Abbott, T. E., Del Arroyo, A. G., Reyes, A., Martir, G., Stephens, R. C., Brealey, D., Cuthbertson, B. H., Wijeysundera, D. N., Pearse, R. M., & Ackland, G. L. (2020). MicroRNA signatures of perioperative myocardial injury after elective noncardiac surgery. British Journal of Anaesthesia, 125(5), 661–671.
[20]	Moosavi, A., & Ozturk, O. (2020). Metaheuristics for the operating theater planning and scheduling: A systematic review. arXiv. https://arxiv.org/abs/2008.04970.
[21]	Nilsson, L., Lindberget, O., Gupta, A., & Vegfors, M. (2009). Implementing a pre-operative checklist to increase patient safety. Acta Anaesthesiologica Scandinavica, 54(2), 176–182.
[22]	Tao, C., & Gao, J. (2016). On building a cloud-based mobile testing infrastructure service system. Journal of Systems and Software, 124, 39–55.
[23]	Wolf, J. A., Moir, M. J., Hanson, H., Friedman, L. H., & Savage, G. T. (2011). Organization development in healthcare: Conversations on research and strategies. Emerald Group Publishing.
[24]	Moss, J. (2002). The operating room charge nurse: Coordinator and communicator. Journal of the American Medical Informatics Association, 9(Suppl. 6), S70–S74.
[25]	Stefanini, A., Aloini, D., & Gloor, P. (2020). Silence is golden: The role of team coordination in health operations. International Journal of Operations & Production Management, 40(9), 1421–1447.
[26]	Teymoori, E., Zareiyan, A., Babajani-Vafsi, S., & Laripour, R. (2022). Viewpoint of operating room nurses about factors associated with occupational burnout: A qualitative study. Frontiers in Psychology, 13.
[27]	Amin, M. A., Baldacci, R., & Kayvanfar, V. (2024). A comprehensive review on operating room scheduling and optimization. Operational Research, 25(1).