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 PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wachtel, R. E. Articles by Dexter, F. Search for Related Content PubMed PubMed Citation Articles by Wachtel, R. E. Articles by Dexter, F. Related Collections Economics and Health Care Research Operating Rooms

---

ECONOMICS, EDUCATION, AND POLICY

A Simple Method for Deciding When Patients Should Be Ready on the Day of Surgery Without Procedure-Specific Data

From the Department of Anesthesia, Division of Management Consulting, University of Iowa, Iowa City, Iowa. Financial disclosure: As director of the Division of Management Consulting, FD receives no funds personally other than his salary from the State of Iowa, including no travel expenses or honoria, and has tenure with no incentive program.

Address correspondence and reprint requests to Franklin Dexter, MD, PhD, Department of Anesthesia, Division of Management Consulting, University of Iowa, Iowa City, IA 52242. Address e-mail to franklin-dexter{at}uiowa.edu. Website www.FranklinDexter.net

Abstract

BACKGROUND: Deciding when patients should arrive for same-day-admission or ambulatory surgery is a problem at many hospitals and surgery centers. Although staff can often start cases earlier than scheduled, the potential start times are not known when each case is scheduled. Patient availability must therefore be balanced against patient waiting times and fasting times. Knowing the earliest time that a case might begin, given its scheduled start time, provides a rational basis for telling patients when to report for surgery and when to refrain from eating or drinking before their procedure.

METHODS: We describe and validate a simple method for determining the earliest possible start time for a case, with only a 5% probability that staff would be able to start the case even earlier. Calculations use nonparametric methods to determine the 0.05 lower prediction bound for the start time of a case, using historical values for the scheduled and actual start times of cases performed by the same surgical suite/surgical service/day of the week combination as the case of interest. Information is not needed regarding the preceding cases performed in the same operating room. No patient or surgeon identifiable information is used.

RESULTS: We use results from earlier studies to provide a derivation and theoretical justification for these methods. New data confirm the validity of the results obtained and show that the required calculations are easy to implement. Individualized patient instructions can be accessed via a public website without disclosing confidential information.

CONCLUSIONS: We have developed a simple method for determining when patients should be ready on the day of surgery based on the start times of historical cases performed by the same surgical suite/surgical service/day of the week combination as the case of interest.

This article has been cited by other articles:

				F. Dexter, E. Marcon, J. Aker, and R. H. Epstein Numbers of Simultaneous Turnovers Calculated from Anesthesia or Operating Room Information Management System Data Anesth. Analg., September 1, 2009; 109(3): 900 - 905. [Abstract] [Full Text] [PDF]

				R. E. Wachtel and F. Dexter Influence of the Operating Room Schedule on Tardiness from Scheduled Start Times Anesth. Analg., June 1, 2009; 108(6): 1889 - 1901. [Abstract] [Full Text] [PDF]

				R. E. Wachtel and F. Dexter Reducing Tardiness from Scheduled Start Times by Making Adjustments to the Operating Room Schedule Anesth. Analg., June 1, 2009; 108(6): 1902 - 1909. [Abstract] [Full Text] [PDF]

				R. E. Wachtel, F. Dexter, and A. J. Dow Growth Rates in Pediatric Diagnostic Imaging and Sedation Anesth. Analg., May 1, 2009; 108(5): 1616 - 1621. [Abstract] [Full Text] [PDF]

				E. U. Dexter, F. Dexter, D. Masursky, M. P. Garver, and N. A. Nussmeier Both Bias and Lack of Knowledge Influence Organizational Focus on First Case of the Day Starts Anesth. Analg., April 1, 2009; 108(4): 1257 - 1261. [Abstract] [Full Text] [PDF]

				F. Dexter, R. H. Epstein, J. D. Lee, and J. Ledolter Automatic Updating of Times Remaining in Surgical Cases Using Bayesian Analysis of Historical Case Duration Data and "Instant Messaging" Updates from Anesthesia Providers Anesth. Analg., March 1, 2009; 108(3): 929 - 940. [Abstract] [Full Text] [PDF]

				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]

				A. Macario, F. Dexter, J. Sypal, N. Cosgriff, and B. T. Heniford Operative Time and Other Outcomes of the Electrothermal Bipolar Vessel Sealing System (LigaSureTM) Versus Other Methods for Surgical Hemostasis: A Meta-Analysis Surgical Innovation, December 1, 2008; 15(4): 284 - 291. [Abstract] [PDF]

				F. Dexter, Y. Xiao, A. J. Dow, M. M. Strader, D. Ho, and R. E. Wachtel Coordination of Appointments for Anesthesia Care Outside of Operating Rooms Using an Enterprise-Wide Scheduling System Anesth. Analg., December 1, 2007; 105(6): 1701 - 1710. [Abstract] [Full Text] [PDF]