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A1175
October 26, 2005 2:00:00 PM - 3:30:00 PM Room C303 |
| Decision Making by Operating Room Managers: The Burden of Changes |
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Richard P. Dutton, M.D., Danny Ho, M.S., Peter F. Hu, M.S., C.N.E., Colin F. Mackenzie, M.D., Yan Xiao, Ph.D. Department of Anesthesia, University of Maryland School of Medicine, Baltimore, Maryland, United States |
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Changes to operating room (OR) schedules during the day of surgery impact OR efficiency and staff satisfaction [1]. Changes require OR managers to react and instigate other changes to coordinate staff, resources and patient needs. We report a method to capture schedule changes and a brief study of the extent and predictors of changes. Method The studied 6 room surgical unit of a major trauma center used a ferrous whiteboard (OR board) to manage daily schedules. Each planned case was written on a magnetic strip that was placed on the OR board in the area of the respective numbered OR in the intended case order. Unassigned cases were grouped together in a designated area on the OR board. OR managers then moved the strips to reflect schedule changes over the day. With approval of Institutional Review Board, the OR board was video-recorded and retrospectively analyzed for changes made between 7AM-7PM on weekdays. Five types of changes were extracted: cancellation, addition, putting a case on hold, changing the case order within an OR and changing rooms. Time of the day, day of the week, number of scheduled cases (posted the day before), number of add-on cases (added over night) at 7AM, and occurrences of emergency cases were tested as predictors of change. Results On 30 consecutive weekdays, the median number of scheduled cases per day was 11 (range: 5-17). On average, there were 17 daily changes (SD=8; range: 6-34). The number of add-on cases at 7AM was a predictor of changes (r=0.4, p<0.05), but the number of scheduled cases was not. The median numbers of canceling, adding, holding, changing case orders and changing rooms were 4, 5, 1, 1, and 3.5, respectively. The numbers were highest for canceling, holding, and case order changing on Mondays. Changes occurred throughout the day although mostly before 9AM (Figure 1). Case canceling occurred most frequently 7-8AM and room reassignment 9-10AM and 11AM-12PM. Emergency cases (N=41 for all days) were added most frequently 10-11AM and 5-6PM, but their occurrences did not correlate with the number of changes. Discussion Changes to the OR schedules in the studied trauma center were common, although they were not usually associated with emergency cases. Add-on cases at the start of the day were the major reason for these changes. Cancellations occurred frequently, about a third of the number of scheduled cases. Cancellations, holding cases and room changes often lead to extra work by the staff and contribute to staff dissatisfaction. The reported method provides a way to understand the timing of such changes and to better allocate resources. For example, the cancellations usually occurred in the first hour of regular OR time, suggesting that minimizing them or communicating cancellations early could reduce schedule changes. As add-on cases are unavoidable in the trauma setting, this data will be useful in seeking additional open OR time to accommodate this work without disrupting the flow of scheduled cases. *Supported in part by Dept Defense (DAMD17032001) [1] Anesth 2004, 101:1444-53[figure1] Anesthesiology 2005; 103: A1175 |
Figure 1
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