Caseload is increased by resequencing cases before and on the day of surgery at ambulatory surgery centers where initial patient recovery is in operating rooms and cleanup times are longer than typical

Abstract

Study objective The coronavirus disease 2019 (COVID-19) pandemic impacts operating room (OR) management in regions with high prevalence (e.g., >1.0% of asymptomatic patients testing positive). Cases with aerosol producing procedures are isolated to a few ORs, initial phase I recovery of those patients is in the ORs, and multimodal environmental decontamination applied. We quantified the potential increase in productivity from also resequencing these cases among those 2 or 3 ORs. Design Computer simulation provided sample sizes requiring >100 years experimentally. Resequencing was limited to changes in the start times of surgeons' lists of cases. Setting Ambulatory surgery center or hospital outpatient department. Main results With case resequencing applied before and on the day of surgery, there were 5.6% and 5.5% more cases per OR per day for the 2 ORs and 3 ORs, respectively, both standard errors (SE) < 0.1%. Resequencing cases among ORs to start cases earlier permitted increases in the hours into which cases could be scheduled from 10.5 to 11.0 h, while assuring >90% probability of each OR finishing within the prespecified 12-h shift. Thus, the additional cases were all scheduled before the day of surgery. The greater allocated time also resulted in less overutilized time, a mean of 4.2 min per OR per day for 2 ORs (SE 0.5) and 6.3 min per OR per day for 3 ORs (SE 0.4). The benefit could be achieved while limiting application of resequencing to days when the OR with the fewest estimated hours of cases has ≤8 h. Conclusions Some ambulatory surgery ORs have unusually long OR times and/or room cleanup times (e.g., infection control efforts because of the pandemic). Resequencing cases before and on the day of surgery should be considered, because moving 1 or 2 cases occasionally has little to no cost with substantive benefit.

Quantifying and interpreting inequality of surgical site infections among operating rooms

“…These results pertaining to individual ORs are important because there are multiple interventions that could reduce surgical site infection that are applied according to the OR (e.g., capital equipment or ultraviolet-C germicidal lights used nightly). 3,[8][9][10][11][12][13][14][15][16][17][18] Even at a large teaching hospital with C Among the 11,958 combinations of date and room with at least one case lasting 196-290 min, those date and room combinations had a median [interquartile range (IQR)] of 2 [2-3] cases, 11.7% with one case. In contrast, among the 15,398 combinations with at least one case of the preceding quartile of duration (126 to 195 min), there were a median [IQR] of 3 [2-3] cases, 7.48% combinations with one case.…”

“…16 In addition, categories of procedures at greater risk for contamination can be limited to a few ORs. 17,18 Because such interventions to reduce infections are implemented for select ORs, knowing the extent to which resulting infections differ among ORs is important. That knowledge could then be applied to making decisions to mitigate infection by investing in infection prevention measures for some but not all ORs.…”

“…Analyses by OR are needed for tactical implementation of infection preventive measures because capital equipment investments and case scheduling changes to reduce infections are determined by OR. [8][9][10][11][12][13][14][15][16][17][18] Nevertheless, the necessity of also considering the combination of OR and specialty is unknown, given that the effect of specialty on Staphylococcus aureus transmission has been heterogeneous among studies. [3][4][5]36,37 Studies showing an association of transmission with specialty all involved the hyper transmissible and more pathogenic strain characteristics of Staphylococcus aureus, specifically phenotype H or sequence type 5.…”

Scheduling staff for ambulatory anaesthesia

“…To make this practical, they limited the allocated time (i.e. the hours into which cases are scheduled) to no longer than that assuring the staff working 12-h shifts would work later more than twelve hours on fewer than 10% of workdays [1]. The authors then examined how to make small revisions to the distribution of surgeons’ cases (i.e., “lists”) among operating rooms.…”

“…The authors then examined how to make small revisions to the distribution of surgeons’ cases (i.e., “lists”) among operating rooms. Lists of cases could be moved among operating rooms the working day before surgery, once all cases had been scheduled, but before cases had started [1]. Lists also could be moved on the day of surgery.…”