This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (23) Citing Articles via Google Scholar Google Scholar Articles by Dexter, F. Articles by Wachtel, R. E. Search for Related Content PubMed PubMed Citation Articles by Dexter, F. Articles by Wachtel, R. E. Related Collections Economics and Health Care Research

---

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

Tactical Decision Making for Selective Expansion of Operating Room Resources Incorporating Financial Criteria and Uncertainty in Subspecialties' Future Workloads

Division of Management Consulting, Departments of Anesthesia and Health Management & Policy, Department of Management Sciences, College of Business, and Department of Anesthesia, University of Iowa

Address correspondence and reprint requests to Franklin Dexter, MD, PhD, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA 52242. Address e-mail to Franklin-Dexter{at}UIowa.edu.

We considered the allocation of operating room (OR) time at facilities where the strategic decision had been made to increase the number of ORs. Allocation occurs in two stages: a long-term tactical stage followed by short-term operational stage. Tactical decisions, approximately 1 yr in advance, determine what specialized equipment and expertise will be needed. Tactical decisions are based on estimates of future OR workload for each subspecialty or surgeon. We show that groups of surgeons can be excluded from consideration at this tactical stage (e.g., surgeons who need intensive care beds or those with below average contribution margins per OR hour). Lower and upper limits are estimated for the future demand of OR time by the remaining surgeons. Thus, initial OR allocations can be accomplished with only partial information on future OR workload. Once the new ORs open, operational decision-making based on OR efficiency is used to fill the OR time and adjust staffing. Surgeons who were not allocated additional time at the tactical stage are provided increased OR time through operational adjustments based on their actual workload. In a case study from a tertiary hospital, future demand estimates were needed for only 15% of surgeons, illustrating the practicality of these methods for use in tactical OR allocation decisions.

This article has been cited by other articles:

				F. Dexter, L. Birchansky, J. M. Bernstein, and R. E. Wachtel Case Scheduling Preferences of One Surgeon's Cataract Surgery Patients Anesth. Analg., February 1, 2009; 108(2): 579 - 582. [Abstract] [Full Text] [PDF]

				D. Masursky, F. Dexter, and N. A. Nussmeier Operating Room Nursing Directors' Influence on Anesthesia Group Operating Room Productivity Anesth. Analg., December 1, 2008; 107(6): 1989 - 1996. [Abstract] [Full Text] [PDF]

				D. Masursky, F. Dexter, C. E. O'Leary, C. Applegeet, and N. A. Nussmeier Long-Term Forecasting of Anesthesia Workload in Operating Rooms from Changes in a Hospital's Local Population Can Be Inaccurate Anesth. Analg., April 1, 2008; 106(4): 1223 - 1231. [Abstract] [Full Text] [PDF]

				P. G. Nagy, R. Konewko, M. Warnock, W. Bernstein, J. Seagull, Yan Xiao, I. George, and A. Park Novel, Web-Based, Information-Exploration Approach for Improving Operating Room Logistics and System Processes Surgical Innovation, March 1, 2008; 15(1): 7 - 16. [Abstract] [PDF]

				F. Dexter and R. H. Epstein Calculating Institutional Support That Benefits Both the Anesthesia Group and Hospital Anesth. Analg., February 1, 2008; 106(2): 544 - 553. [Abstract] [Full Text] [PDF]

				M. Olivares, C. Terwiesch, and L. Cassorla Structural Estimation of the Newsvendor Model: An Application to Reserving Operating Room Time Management Science, January 1, 2008; 54(1): 41 - 55. [Abstract] [PDF]

				R. E. Wachtel and F. Dexter Tactical Increases in Operating Room Block Time for Capacity Planning Should Not Be Based on Utilization Anesth. Analg., January 1, 2008; 106(1): 215 - 226. [Abstract] [Full Text] [PDF]

				M. Van Houdenhoven, J. M. van Oostrum, E. W. Hans, G. Wullink, and G. Kazemier Improving Operating Room Efficiency by Applying Bin-Packing and Portfolio Techniques to Surgical Case Scheduling Anesth. Analg., September 1, 2007; 105(3): 707 - 714. [Abstract] [Full Text] [PDF]

				F. Dexter, A. Willemsen-Dunlap, and J. D. Lee Operating Room Managerial Decision-Making on the Day of Surgery With and Without Computer Recommendations and Status Displays Anesth. Analg., August 1, 2007; 105(2): 419 - 429. [Abstract] [Full Text] [PDF]

				F. Dexter, J. D. Lee, A. J. Dow, and D. A. Lubarsky A Psychological Basis for Anesthesiologists' Operating Room Managerial Decision-Making on the Day of Surgery Anesth. Analg., August 1, 2007; 105(2): 430 - 434. [Abstract] [Full Text] [PDF]

				F. Dexter Operating Room Efficiency in the National Health Service Anesth. Analg., July 1, 2007; 105(1): 291 - 292. [Full Text] [PDF]

				R. E. Wachtel, E. U. Dexter, and F. Dexter Application of a Similarity Index to State Discharge Abstract Data to Identify Opportunities for Growth of Surgical and Anesthesia Practices Anesth. Analg., May 1, 2007; 104(5): 1157 - 1170. [Abstract] [Full Text] [PDF]

				L. O'Neill and F. Dexter Tactical Increases in Operating Room Block Time Based on Financial Data and Market Growth Estimates from Data Envelopment Analysis Anesth. Analg., February 1, 2007; 104(2): 355 - 368. [Abstract] [Full Text] [PDF]

				C. McIntosh, F. Dexter, and R. H. Epstein The Impact of Service-Specific Staffing, Case Scheduling, Turnovers, and First-Case Starts on Anesthesia Group and Operating Room Productivity: A Tutorial Using Data from an Australian Hospital Anesth. Analg., December 1, 2006; 103(6): 1499 - 1516. [Abstract] [Full Text] [PDF]