Thinking Outside the Operating Room: Guidance on Designing a Safe and Effective Minor Procedure Room

Published:November 06, 2022DOI:
      The minor procedure room (MPR) offers numerous advantages over the traditional operating room for performing many common hand surgeries. MPRs require less space, are subject to more practical architectural design standards, and facilitate more judicious use of disposable materials and unnecessary instruments than common hand surgeries. MPRs reduce costs to the system and patient at every step of the surgical workflow and improve efficiency by removing preoperative and postoperative monitoring requirements. Hand surgeons sometimes face resistance when attempting surgery in MPRs, often because of confusion about their design characteristics and capabilities. This article aims to clarify many of the major requirements for establishing an MPR and provide a guide to hand surgeons for performing safe, efficient surgery outside the operating room.

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        • Leblanc M.R.
        • Lalonde J.
        • Lalonde D.H.
        A detailed cost and efficiency analysis of performing carpal tunnel surgery in the main operating room versus the ambulatory setting in Canada.
        Hand (N Y). 2007; 2: 173-178
        • Chatterjee A.
        • McCarthy J.E.
        • Montagne S.A.
        • Leong K.
        • Kerrigan C.L.
        A cost, profit, and efficiency analysis of performing carpal tunnel surgery in the operating room versus the clinic setting in the United States.
        Ann Plast Surg. 2011; 66: 245-248
        • Nguyen C.
        • Milstein A.
        • Hernandez-Boussard T.
        • Curtin C.M.
        The effect of moving carpal tunnel releases out of hospitals on reducing United States health care charges.
        J Hand Surg Am. 2015; 40: 1657-1662
        • Foster B.D.
        • Sivasundaram L.
        • Heckmann N.
        • et al.
        Surgical approach and anesthetic modality for carpal tunnel release: a nationwide database study with health care cost implications.
        Hand (N Y). 2017; 12: 162-167
        • Van Demark Jr., R.E.
        • Becker H.A.
        • Anderson M.C.
        • Smith V.J.S.
        Wide-awake anesthesia in the in-office procedure room: lessons learned.
        Hand (N Y). 2018; 13: 481-485
        • Look N.
        • Lalka A.
        • Korrell H.
        • Kabrick K.
        • Wheeler A.
        • Bolson R.
        Outcomes of orthopedic hand surgeries in minor procedure rooms at a veterans affairs medical center.
        J Hand Surg Glob Online. 2021; 3: 7-11
        • Leblanc M.R.
        • Lalonde D.H.
        • Thoma A.
        • et al.
        Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery.
        Hand (N Y). 2011; 6: 60-63
        • Tulipan J.E.
        • Kim N.
        • Abboudi J.
        • et al.
        Open carpal tunnel release outcomes: performed wide awake versus with sedation.
        J Hand Microsurg. 2017; 9: 74-79
        • Yu J.
        • Ji T.A.
        • Craig M.
        • McKee D.
        • Lalonde D.H.
        Evidence-based sterility: the evolving role of field sterility in skin and minor hand surgery.
        Plast Reconstr Surg Glob Open. 2019; 7e2481
        • Newsome K.
        • McKenny M.
        • Elkbuli A.
        Major and minor surgery: terms used for hundreds of years that have yet to be defined.
        Ann Med Surg (Lond). 2021; 66102409
        • Humphreys H.
        • Coia J.E.
        • Stacey A.
        • et al.
        Guidelines on the facilities required for minor surgical procedures and minimal access interventions.
        J Hosp Infect. 2012; 80: 103-109
        • Facility Guidelines Institute
        Guidelines for Design and Construction of Outpatient Facilities.
        Facility Guidelines Institute, 2018
      1. Ohio Administrative Code. Office Based Surgery. Definition of Terms. In: Ohio Legislative Service Commission. ed. Vol 4731-25-01. 2011.

        • Association of Surgical Technologists
        AST Standards of Practice for Surgical Drapes.
        • Association of Surgical Technologists
        AST Standards of Practice for Surgical Attire, Surgical Scrub.
        Hand Hygiene and Hand Washing, 2008
        • Association of Surgical Technologists
        AST Standards of Practice for Gowning and Gloving.
        • Association of Surgical Technologists
        AST Guidelines for Best Practices for Establishing the Sterile Field in the Operating Room.
        • Rietz A.
        • Barzin A.
        • Jones K.
        • Mounsey A.
        Sterile or non-sterile gloves for minor skin excisions?.
        J Fam Pract. 2015; 64: 723-727
        • Rogues A.M.
        • Lasheras A.
        • Amici J.M.
        • et al.
        Infection control practices and infectious complications in dermatological surgery.
        J Hosp Infect. 2007; 65: 258-263
        • Nuzzi L.C.
        • Greene A.K.
        • Meara J.G.
        • Taghinia A.
        • Labow B.I.
        Surgical site infection after skin excisions in children: is field sterility sufficient?.
        Pediatr Dermatol. 2016; 33: 136-141
        • Kazmers N.H.
        • Stephens A.R.
        • Presson A.P.
        • Yu Z.
        • Tyser A.R.
        Cost implications of varying the surgical setting and anesthesia type for trigger finger release surgery.
        Plast Reconstr Surg Glob Open. 2019; 7e2231
        • Dua K.
        • Blevins C.J.
        • O'Hara N.N.
        • Abzug J.M.
        The safety and benefits of the semisterile technique for closed reduction and percutaneous pinning of pediatric upper extremity fractures.
        Hand (N Y). 2019; 14: 808-813
        • Derkash R.S.
        • Weaver J.K.
        • Berkeley M.E.
        • Dawson D.
        Office carpal tunnel release with wrist block and wrist tourniquet.
        Orthopedics. 1996; 19: 589-590
        • Garon M.T.
        • Massey P.
        • Chen A.
        • Carroll T.
        • Nelson B.G.
        • Hollister A.M.
        Cost and complications of percutaneous fixation of hand fractures in a procedure room versus the operating room.
        Hand (N Y). 2018; 13: 428-434
        • Davidson J.
        • Ioanidis K.
        • Fantillo V.
        • Paradis J.
        • Strychowsky J.
        Cost and efficiency of myringotomy procedures in minor procedure rooms compared to operating rooms.
        Laryngoscope. 2020; 130: 242-246
        • Small N.C.
        • Bert J.M.
        Office ambulatory surgery centers: creation and management.
        J Am Acad Orthop Surg. 2003; 11: 157-162
        • Hyatt B.T.
        • Saucedo J.M.
        Bedside procedures in hand surgery.
        J Hand Surg Am. 2018; 43: 1144 e1141-1144 e1146
        • Lalonde D.
        • Martin A.
        Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia.
        J Am Acad Orthop Surg. 2013; 21: 443-447
        • Lalonde D.H.
        • Wong A.
        Dosage of local anesthesia in wide awake hand surgery.
        J Hand Surg Am. 2013; 38: 2025-2028
        • McKee D.E.
        • Lalonde D.H.
        • Thoma A.
        • Glennie D.L.
        • Hayward J.E.
        Optimal time delay between epinephrine injection and incision to minimize bleeding.
        Plast Reconstr Surg. 2013; 131: 811-814
        • Chowdhry S.
        • Seidenstricker L.
        • Cooney D.S.
        • Hazani R.
        • Wilhelmi B.J.
        Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases.
        Plast Reconstr Surg. 2010; 126: 2031-2034
        • Denkler K.
        A comprehensive review of epinephrine in the finger: to do or not to do.
        Plast Reconstr Surg. 2001; 108: 114-124
        • Denkler K.
        Myth of not using lidocaine with epinephrine in the digits.
        Am Fam Physician. 2010; 81: 1188
        • Denkler K.A.
        Epinephrine in the digits.
        Plast Reconstr Surg. 2011; 128: 598-599
        • Fitzcharles-Bowe C.
        • Denkler K.
        • Lalonde D.
        Finger injection with high-dose (1:1,000) epinephrine: Does it cause finger necrosis and should it be treated?.
        Hand (N Y). 2007; 2: 5-11
        • Vinycomb T.I.
        • Sahhar L.J.
        Comparison of local anesthetics for digital nerve blocks: a systematic review.
        J Hand Surg Am. 2014; 39: 744-751
        • Bismil M.
        • Bismil Q.
        • Harding D.
        • Harris P.
        • Lamyman E.
        • Sansby L.
        Transition to total one-stop wide-awake hand surgery service-audit: a retrospective review.
        JRSM Short Rep. 2012; 3: 23
        • Davison P.G.
        • Cobb T.
        • Lalonde D.H.
        The patient's perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study.
        Hand (N Y). 2013; 8: 47-53
        • Rhee P.C.
        • Fischer M.M.
        • Rhee L.S.
        • McMillan H.
        • Johnson A.E.
        Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures.
        J Hand Surg Am. 2017; 42: e139-e147
        • Teo I.
        • Lam W.
        • Muthayya P.
        • Steele K.
        • Alexander S.
        • Miller G.
        Patients' perspective of wide-awake hand surgery—100 consecutive cases.
        J Hand Surg Eur Vol. 2013; 38: 992-999