Elective change of surgeon during the OR day has an operationally negligible impact on turnover time

Abstract

Study Objective To compare turnover times for a series of elective cases with surgeons following themselves to turnover times for a series of previously scheduled, elective procedures where the following surgeon differed from the preceding surgeon. We also considered the effect of changing procedure types and the time of day on turnover time. Design Retrospective, cohort study. Setting University-affiliated teaching hospital. Measurements We used the operating room statistical database to gather 32 months of turnover data from a large academic institution. Turnover time data for the same-surgeon and surgeon-swap groups were batched by month to minimize autocorrelation and achieve data normalization. A two-way ANOVA using the monthly batched data was performed with surgeon swapping and changes in procedure category as variables of turnover time. Similar analyses were performed using individual surgical services and using hourly time intervals during the surgical day as additional covariates to surgeon swapping. Main Results The mean (95% confidence interval) same-surgeon turnover time was 43.6 (43.2 – 44.0) min versus 51.0 (50.5 – 51.6) min for a planned surgeon swap (p < 0.0001). This resulted in a difference (95% confidence interval) of 7.4 (6.8 – 8.1) min. The exact increase in turnover time was dependent on surgical service, change in subsequent procedure type, time of day when the turnover occurred, and turnover frequency per OR. Conclusions The investigated institution averages 2.5 cases per OR per day. The cumulative additional turnover time (far less than one hour per operating room per day) for switching surgeons definitely does not allow the addition of another elective procedure if the difference could be eliminated. A flexible scheduling policy allowing surgeon swapping rather than requiring full blocks incurs minimal additional staffed time during the OR day while allowing the schedule to be filled with available elective cases.

Discrepancies Between Planned and Actual Operating Room Turnaround Times at a Large Rural Hospital in Germany

“…4,7 However, Austin et al determined that a change in surgeon had a negligible effect on OR turnover time. 9 Despite evidence that these individuals hold much of the responsibility for procedural efficiency, Masursky et al previously found that surgeons were biased when it came to planning OR turnaround times. 11,13 Correcting discrepancies between planned and actual OR turnaround times can reduce patient wait times, potentially enabling more procedures to be performed in a single OR, especially when numerous short surgeries are scheduled.…”

“…4,5,7,8 In contrast, a change in surgeon has been found to have no significant impact on OR efficiency. 9 In an in-depth analysis of OR data, including causes of delays and personal accountability, Overdyk et al found that teamwork improved OR efficiency. 10 However, Masursky et al observed that both surgeons and, to a lesser extent, anaesthesiologists, judged OR turnaround times according to mental models of factors influencing turnover; thus, the perceptions of surgeons or anaesthesiologists should not be relied upon to make OR management decisions.…”

Large Heterogeneity in Mean Durations of Labor Analgesia Among Hospitals Reporting to the American Society of Anesthesiologists’ Anesthesia Quality Institute

“…Statistical analyses are commonly done after batching (binning) the data into 4-week periods, because managerial covariates are often unmeasured, not only nationwide but at individual hospitals (e.g., staff schedules and correlations among patients caused by appropriate queue management based on threshold numbers of patients). [11][12][13][14][15][16][17][18][19][20] For example, we used the Kruskal-Wallis test to compare the labor epidural durations among the 7 days of the week. At random, 1.0% of the 175 hospitals should be statistically significant at a P < 0.01 criterion, but 10.6% www.anesthesia-analgesia.org…”

Managerial Decision-making for Daily Case Allocation Scheduling and the Impact on Perioperative Quality Assurance

“…(11)(12)(13) OR scheduling covers two different levels: monthly staff scheduling and daily allocation scheduling (daily staff assignment). (14) By definition, the former refers to long-term scheduling, whereas the latter refers to day-to-day function. Staff scheduling is the process of deciding which staff is available on a given day for a given shift.…”