Improving O.R. efficiency means reducing over-utilization

Franklin Dexter, M.D., Ph.D., explains methods to improve O.R. efficiency.

In the O.R., time is money. To run an O.R. efficiently, “reduce your hours of over-utilization,” said Franklin Dexter, M.D., Ph.D. In other words, do what you can to avoid ending later than scheduled.

Monday, during “Improving First-Case-of-the-Day On Time Starts CAN Increase Operating Room Efficiency,” Dr. Dexter presented evidence-based principles for reducing O.R. over-utilization. He is the Director of the Division of Management Consulting and Professor of Anesthesia at the University of Iowa.

Here are highlights:

Crunch the numbers. O.R. over-utilization should be based on a mathematical formula, not a committee, Dr. Dexter said. He provided three equations for evaluating O.R. time. One is: Inefficiency of use of O.R. time = (Cost per hour of under-utilized O.R. time) x (hours of under-utilized O.R. time) + (Cost per hour of over-utilized O.R. time) x (hours of over-utilized O.R. time). Allocated O.R. times are the hours in which cases, not staff, are scheduled. Doing the math leads to better management decisions regarding O.R. allocations before and on the day of surgery. You can find the other two equations for maximizing O.R. efficiency on Dr. Dexter’s website.

Reduce tardiness of first-case starts. “It’s twice as expensive to start late in the O.R. than early or on time,” Dr. Dexter said. A common assumption is that surgeons are the main cause of late first-case-of-the day starts; tardiness of first-case starts is attributed to the anesthesiologist only 1 percent of the time. But targeting surgeons to improve start times isn’t necessarily the answer. “Efficiency is a chain of events that starts with the least expensive member of the team,” Dr. Dexter said. Research shows that when people who move patients to the holding area get them there on time, anesthesiologists and surgeons respond by being on time, too.

Examine perceptions and bias. Cognitive bias leads to O.R. inefficiency. It’s a common assumption, that if the first case of the day starts late, the rest of the day’s cases will be late. “That’s not true because most cases take less time than scheduled,” Dr. Dexter said. Another common assumption is that when the O.R. is under-utilized, you are ahead of schedule and the O.R. team will not be pressured to be efficient. “That’s not true. People don’t slow down,” Dr. Dexter said.

Send notifications on the day of surgery. Automated recommendations keep everyone on task and enhance first-case-of-the-day starts, Dr. Dexter said. He recommended that O.R. managers provide electronic displays or notify members of the O.R. team with evidence-based recommendations. Include O.R. allocations calculated based on maximizing efficiency of use of O.R. time, he said.

Plan the working day before surgery. Manage the operating rooms with expected over-utilization times more effectively. For example, training anesthesiology residents increases the O.R. time before the start of surgery by a mean of four minutes. To save time, “assign operating rooms with over-utilization to anesthesiologists who are working alone,” Dr. Dexter said.

Do a literature search. If you have a particular O.R. inefficiency problem, check the engineering literature for the solution. O.R. efficiency studies aren’t on Pubmed. Rely on scientific studies. “Organizations put too much emphasis on their own data, but that’s a waste of time because so many problems have already been resolved,” Dr. Dexter said.


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