Operating room spatial layout, capacity utilization, and resource efficiency: evidence from a tertiary hospital in China

Purpose Operating rooms (ORs) are among the most resource-intensive hospital units. This study examines how OR spatial layout influences surgical preparation time, staff movement, equipment utilization, patient flow, and OR utilization in a large tertiary hospital in China. Design/methodology/approach A single-site, observed-baseline and simulated-optimization operational study was conducted using anonymized OR operational records, spatial layouts, equipment-location data, and workflow-route indicators from January to December 2023. The analytic file contained 19 ORs, five paired audit blocks, and 95 OR-period observations for spatial and regression analysis. The optimized layout was evaluated as a GIS/BIM-informed simulation scenario rather than as a hospital-wide observed post-implementation intervention. GIS network mapping, BIM-based scenario modeling, paired process-time analysis, variance testing, multivariate regression with OR-level clustering, and AnyLogic-based discrete-event simulation were used to compare the observed baseline with the optimized scenario. Findings The optimized scenario was associated with a 15.2-min reduction in preparation time, from 45.6 ± 1.3 to 30.4 ± 1.3 min; a 20.8 percentage-point increase in equipment utilization, from 64.6 ± 1.3% to 85.4 ± 1.3%; and a 16.4 percentage-point increase in OR utilization, from 64.0 ± 0.62% to 80.4 ± 1.3%. Simulation outputs also indicated lower patient waiting time, lower OR vacancy rate, and reduced staff movement frequency. Because the optimized layout was evaluated through calibrated simulation, the findings should be interpreted as layout-associated scenario estimates rather than isolated causal effects. Originality/value This study contributes to healthcare operations management by conceptualizing OR spatial layout as an operational resource that influences process flow, equipment accessibility, staff movement, and capacity use. It also develops a reproducible GIS/BIM–simulation framework to support evidence-informed OR redesign in high-volume tertiary hospital settings.