Making Management Decisions on the Day of Surgery Based on Operating Room Efficiency and Patient Waiting Times

Dexter, Franklin; Epstein, Richard H.; Traub, Rodney D.; Xiao, Yan; Warltier, David C.

doi:10.1097/00000542-200412000-00027

Cited by 215 publications

(165 citation statements)

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“…One example is the work undertaken by Dexter et al on sequencing emergency cases in the US. 16 Although clinical decisions were deemed a priority, Dexter et al attempted to integrate the notion of logistical importance. One exemplar solution was to provide surgeons with open access to operating room time on the work day of choice.…”

Section: Discussionmentioning

confidence: 99%

“…This may explain the conflict that can arise between stakeholders when deciding emergency schedules. 4,16 Operational variables that are influenced by command or administrative factors were found to be less important. This can be explained by clinical decision making practices taking precedence when determining queue position of unplanned surgical cases.…”

Section: Perceptions Of Delays By Surgeons Anaesthetists Nurses Andmentioning

confidence: 96%

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Beyond clinical priority: what matters when making operational decisions about emergency surgical queues?

Fitzgerald¹,

Wu²

2017

Aust. Health Review

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Objective. This paper describes the perceptions of operating theatre staff in Australia and The Netherlands regarding the influence of logistical or operational reasons that may affect the scheduling of unplanned surgical cases. It is proposed that logistical or operational issues can influence the priority determination of queue position of surgical cases on the emergency waiting list.Methods. A questionnaire was developed and conducted in 15 hospitals across The Netherlands and Australia, targeting anaesthetists, managers, nurses and surgeons. Statistical analyses revolved around these four professional groups. Six hypotheses were then developed and tested based on the responses collected from the participants.Results. There were significant differences in perceptions of logistics delay factors across different professional groups when patients were waiting for unplanned surgery. There were also significant differences among different groups when setting logistical priority factors for planning and scheduling unplanned cases. The hypotheses tests confirm these differences, and the findings concur with the paradigmatic differences mentioned in the literature. These paradigmatic differences among the four professional groups may explain some of the tensions encountered when making decisions about scheduling emergency surgical queues, and therefore should be taken into consideration for management of operating theatres.Conclusions. Queue positions of patients waiting for unplanned surgery, or emergency surgery, are determined by medical clinicians according to clinicians' indication of clinical priority. However, operating theatre managers are important in facilitating smooth operations when planning for emergency surgeries. It is necessary for surgeons to understand the logistical challenges faced by managers when requesting logistical priorities for their operations.What is known about the topic? Tensions exist about the efficient use of operating theatres and negotiating individual surgeon's demands, especially between surgeons and managers, because in many countries surgeons only work in the hospital and not for the hospital. What does this paper add? The present study examined the logistical effects on functionality and purports the notion that, while recognising the importance of clinical precedence, logistical factors influence queue order to ensure efficient use of operating theatre resources. What are the implications for practitioners? The results indicate that there are differences in the perceptions of healthcare professionals regarding the sequencing of emergency patients. These differences may lead to conflicts in the decision making process about triaging emergency or unplanned surgical cases. A clear understanding of the different perceptions of different functional groups may help address the conflicts that often arise in practice.

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Section: Discussionmentioning

confidence: 99%

Section: Perceptions Of Delays By Surgeons Anaesthetists Nurses Andmentioning

confidence: 96%

Beyond clinical priority: what matters when making operational decisions about emergency surgical queues?

Fitzgerald¹,

Wu²

2017

Aust. Health Review

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“…The remainder of this section subsequently addresses each level. For a complete overview of the literature concerning OR planning and scheduling we refer to (Denton et al 2007;Dexter et al 1999aDexter et al , 1999bDexter et al , 2004Guinet and Chaabane 2003;Hans et al 2008;McIntosh et al 2006;Pham and Klinkert 2008;Sier et al 1997;Van Houdenhoven et al 2007b;Zhou and Dexter 1998).…”

Section: A Hierarchical Overview Of or Planning And Schedulingmentioning

confidence: 99%

“…Obviously at this level of control, all uncertainty materializes and has to be dealt with. If necessary, surgeries are rescheduled, or even canceled (Dexter et al 2004;McIntosh et al 2006). This is usually done by a day coordinator in the OR department.…”

Section: Online Operational or Planning And Schedulingmentioning

confidence: 99%

“…of operating room (OR) department planning and scheduling has always been a popular subject (Dexter et al 2004;Gerchak et al 1996;Guinet and Chaabane 2003;Hans et al 2008;Lamiri et al 2008). As approximately 60% of all inpatient admissions consist a visit to an OR department, and various scarce and expensive resources are involved, it is apparent that its efficiency is paramount.…”

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confidence: 99%

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Suitability and managerial implications of a Master Surgical Scheduling approach

2009

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Operating room (OR) planning and scheduling is a popular and challenging subject within the operational research applied to health services research (ORAHS). However, the impact in practice is very limited. The organization and culture of a hospital and the inherent characteristics of its processes impose specific implementation issues that affect the success of planning approaches. Current tactical OR planning approaches often fail to account for these issues. Master surgical scheduling (MSS) is a promising approach for hospitals to optimize resource utilization and patient flows. We discuss the pros and cons of MSS and compare MSS with centralized and decentralized planning approaches. Finally, we address various implementation issues of MSS and discuss its suitability for hospitals with different organizational foci and culture.Keywords Master surgical scheduling · Organizational issues · Operating room management · Organizational focus and culture · Health care operations planning and scheduling

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Surgery Planning and Scheduling

Erdogan

Denton

Fitts³

2011

Wiley Encyclopedia of Operations Research and Management Science

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In 2007, total health-care spending in the United States reached US $2.3 trillion, and continues to rise at the fastest rate in US history. The design and implementation of better planning and scheduling systems is an important area to study in order to reduce high costs and improve access to services in the health-care system. Surgery scheduling, in particular, is an area with significant potential for realizing greater efficiencies. Poor scheduling prevents health-care providers from matching patient demand with available capacity, causing inefficient use of resources, decreased return on investment, and long waiting lists for patients. It has been estimated that surgery accounts for more than 40% of a hospital's total revenues and expenses. Recent studies indicate that resource utilization, overtime, and on-time start performance within surgical suites could be improved at most hospitals. These important performance measures are influenced in part by the surgery scheduling systems and policies that are used in practice.Surgery scheduling systems impact a variety of expensive resources including operating rooms (ORs), the postanesthesia care unit (PACU), intensive care unit (ICU), hospital beds, equipment resources such as mobile diagnostic imaging devices, and human resources including surgeons, nurses, anesthesiologists, and other staff. The unpredictable nature of surgery results in uncertainty in the duration of surgery and patient recovery. This can be caused by many factors including the varying experience of surgeons and OR teams, the presence of residents or surgical fellows in

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Making Management Decisions on the Day of Surgery Based on Operating Room Efficiency and Patient Waiting Times

Cited by 215 publications

References 3 publications

Beyond clinical priority: what matters when making operational decisions about emergency surgical queues?

Beyond clinical priority: what matters when making operational decisions about emergency surgical queues?

Suitability and managerial implications of a Master Surgical Scheduling approach

Surgery Planning and Scheduling

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