Impact of changed management policies on operating room efficiency

Abstract

BackgroundTo increase operating room (OR) efficiency, a new resource allocation strategy, a new policy for patient urgency classification, and a new system for OR booking was implemented at a tertiary referral hospital. We investigated the impact of these interventions.MethodsWe carried out a before-and-after study using OR data. A total of 23 515 elective (planned) and non-elective (unplanned) orthopaedic and general surgeries were conducted during calendar year 2007 (period 1) and July 2008 to July 2009 (period 2). The Wilcoxon–Mann–Whitney test was used to calculate statistical significance.ResultsAn increased amount of case time (7.1%, p < 0.05) was conducted without any increase in out-of-hours case time. Despite having three fewer ORs for electives, slightly more elective case time was handled with 26% less use of overtime (p < 0.05). Mean OR utilization was 56% for the 17 mixed ORs, 60% for the 14 elective ORs, and 62% for the 3 dedicated ORs. A 20% growth (p < 0.05) of non-elective case time was primarily absorbed through enhanced daytime surgery, which increased over 48% (p < 0.05). As a result, the proportions of case time on evenings and nights decreased. Specifically, case time at night decreased by 26% (p < 0.05), and the number of nights without surgery increased from 55 to 112 (out of 315 and 316, respectively). Median waiting time for the middle urgencies increased with 1.2 hours, but over 90% received treatment within maximum acceptable waiting time (MAWT) in both periods. Median waiting time for the lowest urgencies was reduced with 12 hours, and the proportion of cases treated within MAWT increased from 70% to 89%. The proportion of high urgency patients (as a proportion of the total) was reduced from 20% to 12%. Consequently, almost 90% of the operations could be planned at least 24 hours in advance.ConclusionsThe redesign facilitated effective daytime surgery and a more selective use of the ORs for high urgency patients out of hours. The synergistic effect probably exceeded the sum of the individual effects of the changes, because the effects of each intervention facilitated the successful implementation of others.

Trade-Offs in Operating Room Planning for Electives and Emergencies: A Review

“…However, the utilization of the DORs ranges from 24% to 85% and depends on several factors like case mix, patient volume and scheduling policies. In contrast to the other authors, Sandbaek et al [78] show that the OR utilization for both the dedicated ORs and the elective ORs is higher than in the flexible policy. However, since they implement also a new classification and booking system, this effect might be caused by other factors than the dedicated policy.…”

“…Also Sandbaek et al [78] provide information on both the median waiting time and the proportion of patients within their target time. Interestingly, the results differ for the three non-elective categories.…”

“…This categorization recognizes that scheduling lower-priority patients later in the time horizon provides additional flexibility to schedule higher-priority patients [69]. Similarly, Sandbaek et al [78] show that introducing a new classification system resulted in a system where 90% of the patients could be planned ahead. Conversely, questions can be raised about the quality of the common medical categorization, as reflected in Table 5.…”

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

“…Appropriate schedule management could reduce complication rates and increase efficiency of perioperative management, which plays an important role in the provision of overall services of the hospital. (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.…”

Managing urgent care in hospitals

“…Noted should be however that during the study several changes occurred such as an increase in surgeons, as well the number of surgeries performed. Sandbaek et al [214] carry out a before and after analysis of implementing a dedicated policy (from a flexible policy), where three ORs are reserved for emergency patients. They report a reduction in overtime for both elective and emergency ORs, as well as an increase in utilization.…”