Operating rooms require precise coordination between clinical and nonclinical teams, yet many essential workflow steps often go undocumented or are recorded late. At Houston Methodist’s Walter Tower, the Apella AI platform is revolutionizing this process by accurately and swiftly capturing numerous additional nonclinical and periclinical events.

Ngoc‑Anh Nguyen, MD, who led a recent study evaluating the technology’s impact, says the shift has been significant.

“The image‑based AI tells you all the other events — back table open, transfer to OR table, intubation. Those are big events that happen before anesthesia is ready, and they’re important for surgeons who may be running multiple rooms,” Dr. Nguyen says.

A clearer view of the OR workflow

Traditionally, circulating nurses manually document events such as patient arrival, anesthesia readiness, case start and case end. But many other steps — room setup, patient transfer, induction — happen in the background and are hard to capture in real time.

The new system uses wall‑mounted cameras in each OR to automatically identify and timestamp these moments. It also sends text alerts to surgeons when a patient arrives, when the patient is draped and when the case ends.

“Surgeons love this,” Dr. Nguyen says. “It reliably tells them when they’re needed so they’re not waiting around or guessing.”

A 7% increase in case volume

To measure the technology’s impact, Dr. Nguyen’s team compared 10 months of postimplementation data with six months of preimplementation data. They used a synthetic control model — a composite of multiple ORs with similar pre-implementation patterns — to estimate what Walter Tower’s performance would have looked like without the new system.

The team found a 7% increase in case volume, amounting to 25 additional cases per month. The case mix remained stable, with cardiothoracic and vascular cases consistently representing 86-87%. Operative minutes did not decrease, indicating surgeons were not operating faster. However, turnover times decreased, enabling more cases to be completed within the same OR hours.

“More cases are completed in the same amount of OR time,” Dr. Nguyen says. “We were able to do that because we cut the periclinical period shorter.”

Real‑time video helps every team improve

The video clips generated by the system have become valuable tools for OR management, housekeeping, infection control and anesthesia leadership. Teams can review turnover workflows, identify bottlenecks and investigate outliers, such as unusually long induction times.

“You can’t really do that from a spreadsheet. You can do that from video,” Dr. Nguyen notes.

The technology also supports more efficient block scheduling. “A human doing it on an Excel sheet is way less efficient,” she says. “AI can slot cases together like Tetris.”

Dr. Nguyen credits Rose McCullogh, the operations director at Walter Tower, for embracing the system and maximizing its value.

“A technology is only as good as the people who use it well,” Dr. Nguyen says.

Patients also benefit

Although the system focuses on nonclinical workflow, the downstream effects directly benefit patients.

“Everybody is interested in starting on time. Patients don’t want to wait,” Dr. Nguyen said.

Shorter turnover times lead to fewer delays on the day of surgery, shorter anesthesia durations and reduced wait times for scheduling future procedures.

Other health systems have reported lower infection rates after adopting similar technology, thanks to improved monitoring of terminal cleaning. Houston Methodist plans to explore these outcomes as well.

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Ethical and legal safeguards

Staff expressed concerns about surveillance, data security and privacy, prompting extensive discussions with legal, ethics and operations teams.

Dr. Nguyen and her colleagues published a paper outlining the safeguards they established. Video is retained for only 30 days; no audio is captured or stored; and the vendor manages data securely. For patients, clear signage is posted in ORs and consent is incorporated into universal consent for care.

A team‑centered future for OR innovation

Dr. Nguyen hopes readers understand that the technology isn’t about changing how surgeons operate. It’s about optimizing everything around the clinical moment.

“Surgery is a teamwork environment that requires a lot of different people,” she says. “Even if the system was OK before, we always want to be safer and more efficient. That’s really why we did this.”