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ECONOMICS, EDUCATION, AND POLICY

An Observational Study of Surgeons' Sequencing of Cases and Its Impact on Postanesthesia Care Unit and Holding Area Staffing Requirements at Hospitals

Eric Marcon, PhD^*, and Franklin Dexter, MD, PhD

From the *Department of Manufacturing System Management and Maintenance, Jean Monnet University, Saint Etienne, France; Departments of Anesthesia, and Health Management and Policy, University of Iowa, Iowa City, Iowa.

Address correspondence and reprint requests to Franklin Dexter, Anesthesia 6-JCP, University of Iowa, Iowa City, IA 52242. Address e-mail to franklindexter{at}uiowa.edu.

Abstract

BACKGROUND: Staffing requirements in the operating room (OR) holding area and in the Phase I postanesthesia care unit (PACU) are influenced by the sequencing of each surgeon's list of cases in the same OR on the same day.

METHODS: Case sequencing was studied using 201 consecutive workdays of data from a 10 OR hospital surgical suite.

RESULTS: The surgeons differed significantly among themselves in their sequencing of cases and were also internally nonsystematic, based on case durations. The functional effect of this uncoordinated sequencing was for the surgical suite to behave overall as if there was random sequencing. The resulting PACU staffing requirements were the same as those of the best sequencing method identified in prior simulation studies. Although sequencing "Longest Cases First" performs poorly when all ORs have close to 8 h of cases, at the studied hospital it performed no worse than the other methods. The reason was that some ORs were much busier than others on the same day. The standard deviation among ORs in the hours of cases, including turnovers, was 3.2 h; large relative to the mean workload. Data from 33 other hospitals confirmed that this situation is commonplace. Additional studies showed that case sequencing also had minimal effects on the peak number of patients in the holding area.

CONCLUSIONS: The uncoordinated decision-making of multiple surgeons working in different ORs can result in a sufficiently uniform rate of admission of patients into the PACU and holding that the independent sequencing of each surgeon's list of cases would not reduce the incidence of delays in admission or staffing requirements.

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