The limitations of using operating room utilisation to allocate surgeons more or less surgical block time in the USA

Healthcare providers in both public and private sectors are facing increasing pressure to improve their cost efficiency and productivity. The increasing cost of new technological solutions has enforced to apply operations management techniques developed for industrial and service processes. Meyer’s (2004) review of existing research shows that, on average, operating rooms (ORs) operate only at 68% of capacity. Using OR time efficiently is especially challenging when long operations are scheduled to fixed OR block time. This situation is typical in open heart surgeries, where a high variability in the length of required OR time combined with four and a half hour average OR time duration makes scheduling two operations during a normal eight hour workday difficult. The objective of this paper is to analyze the effect that three different process interventions have on the OR cost in OR performing open heart surgeries. The investigated process interventions are 4 days OR week (4D), the better accuracy of operating room time forecast (F) and doing anesthesia induction outside the OR (I). These interventions were emerged from practical organization context. This paper is organized as follows. First we provide a review of the existing literature on measures of OR utilization and investigated three interventions. Based on existing literature we construct a simulation model to test the interventions’ effect on OR utilization. Conclusions of results are presented and practical implications and new contribution to existed theory of operating room management is discussed.

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Operating Room Utilization Alone Is Not an Accurate Metric for the Allocation of Operating Room Block Time to Individual Surgeons with Low Caseloads

Anesthesiology ◽

10.1097/00000542-200305000-00029 ◽

2003 ◽

Vol 98 (5) ◽

pp. 1243-1249 ◽

Cited By ~ 45

Author(s):

Srinivasa N. Raja ◽

Franklin Dexter ◽

Alex Macario ◽

Rodney D. Traub ◽

David A. Lubarsky

Keyword(s):

Computer Simulation ◽

Operating Room ◽

Historical Data ◽

Discrete Event ◽

Organizational Conflict ◽

Or Efficiency ◽

Block Time ◽

Utilization Data ◽

Low Volume ◽

Average Block

Introduction Many surgical suites allocate operating room (OR) block time to individual surgeons. If block time is allocated to services/groups and yet the same surgeon invariably operates on the same weekday, for all practical purposes block time is being allocated to individual surgeons. Organizational conflict occurs when a surgeon with a relatively low OR utilization has his or her allocated block time reduced. The authors studied potential limitations affecting whether a facility can accurately estimate the average block time utilizations of individual surgeons performing low volumes of cases. Methods Discrete-event computer simulation. Results Neither 3 months nor 1 yr of historical data were enough to be able to identify surgeons who had persistently low average OR utilizations. For example, with 3 months of data, the widths of the 95% CIs for average OR utilization exceeded 10% for surgeons who had average raw utilizations of 83% or less. If during a 3-month period a surgeon's measured adjusted utilization is 65%, there is a 95% chance that the surgeon's average adjusted utilization is as low as 38% or as high as 83%. If two surgeons have measured adjusted utilizations of 65% and 80%, respectively, there is a 16% chance that they have the same average adjusted utilization. Average OR utilization can be estimated more precisely for surgeons performing more cases each week. Conclusions Average OR utilization probably cannot be estimated precisely for low-volume surgeons based on 3 months or 1 yr of historical OR utilization data. The authors recommend that at surgical suites trying to allocate OR time to individual low-volume surgeons, OR allocations be based on criteria other than only OR utilization (e.g., based on OR efficiency).

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Scheduling Surgical Cases into Block Time—Computer Simulation of the Effects of Scheduling Strategies on Operating Room Labor Costs

Survey of Anesthesiology ◽

10.1097/00132586-200106000-00010 ◽

2001 ◽

Vol 45 (3) ◽

pp. 137-138

Keyword(s):

Computer Simulation ◽

Operating Room ◽

Labor Costs ◽

Block Time ◽

Scheduling Strategies

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An Operating Room Scheduling Strategy to Maximize the Use of Operating Room Block Time

Anesthesia & Analgesia ◽

10.1213/00000539-199907000-00003 ◽

1999 ◽

Vol 89 (1) ◽

pp. 7-20 ◽

Cited By ~ 20

Author(s):

Franklin Dexter ◽

Alex Macario ◽

Rodney D. Traub ◽

Margaret Hopwood ◽

David A. Lubarsky

Keyword(s):

Operating Room ◽

Operating Room Scheduling ◽

Scheduling Strategy ◽

Block Time

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An Operating Room Scheduling Strategy to Maximize the Use of Operating Room Block Time

Anesthesia & Analgesia ◽

10.1097/00000539-199907000-00003 ◽

1999 ◽

Vol 89 (1) ◽

pp. 7-20 ◽

Cited By ~ 35

Author(s):

Franklin Dexter ◽

Alex Macario ◽

Rodney D. Traub ◽

Margaret Hopwood ◽

David A. Lubarsky

Keyword(s):

Operating Room ◽

Operating Room Scheduling ◽

Scheduling Strategy ◽

Block Time

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Overlapping Induction of Anesthesia

Anesthesiology ◽

10.1097/00000542-200508000-00023 ◽

2005 ◽

Vol 103 (2) ◽

pp. 391-400 ◽

Cited By ~ 77

Author(s):

Robert Hanss ◽

Björn Buttgereit ◽

Peter H. Tonner ◽

Berthold Bein ◽

Andreas Schleppers ◽

...

Keyword(s):

Operating Room ◽

Subgroup Analysis ◽

Economic Benefit ◽

Turnover Time ◽

Case Mix ◽

Start Time ◽

Case Mix Index ◽

Control Time ◽

Block Time ◽

Additional Costs

Background Overlapping induction (OI), i.e., induction of anesthesia with an additional team while the previous patient is still in the operating room (OR), was investigated. Methods The study period was 60 days in two followed by three ORs during surgical Block Time (7:30 am until 3:00 pm). Patients were admitted the day before surgery and were thus available and did not have surgery that day unless there was a time reduction. Facilities were already constructed. Number of cases, Nonsurgical Time (Skin Suture Finish until next Procedure Start Time), Turnover Time, and Anesthesia Control Time plus Turnover Time were studied. In addition, economic benefit was calculated. Results Three hundred thirty-five cases were studied. Using OI, the time of care of regularly scheduled cases was shortened, and the number of cases performed within OR Block Time increased (151 to 184 cases; P < 0.05). Nonsurgical Time (in h:min) decreased (1:08 +/- 0:26 to 0:57 +/- 0:18; P < 0.001), Turnover Time decreased (0:38 +/- 0:24 to 0:25 +/- 0:15; P < 0.05), and Anesthesia Control Time plus Turnover Time decreased (0:43 +/- 0:23 to 0:28 +/- 0:18; P < 0.001). Subgroup analysis showed a significant benefit of OI only in three ORs. In three ORs, economic benefit can be gained at a case mix index greater than 0.3 besides additional costs. Conclusions Overlapping induction increased productivity and profit despite the expense of additional staff. Subgroup analysis emphasizes the importance of the number of ORs involved in OI.

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