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ECONOMICS, EDUCATION, AND POLICY

Operating Room Managerial Decision-Making on the Day of Surgery With and Without Computer Recommendations and Status Displays

Franklin Dexter, MD, PhD^*, Ann Willemsen-Dunlap, CRNA, PhD^*, and John D. Lee, PhD

From the Departments of *Anesthesia, Health Management and Policy, and Mechanical and Industrial Engineering, University of Iowa, Iowa City, Iowa.

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

Abstract

BACKGROUND: There are three basic types of decision aids to facilitate operating room (OR) management decision-making on the day of surgery. Decision makers can rely on passive status displays (e.g., big screens or whiteboards), active status displays (e.g., text pager notification), and/or command displays (e.g., text recommendations about what to do).

METHODS: Anesthesiologists, OR nurses, and housekeepers were given nine simulated scenarios (vignettes) involving multiple ORs to study their decision-making. Participants were randomized to one of four groups, all with an updated paper OR schedule: with/without command display and with/without passive status display.

RESULTS: Participants making decisions without command displays performed no better than random chance in terms of increasing the predictability of work hours, reducing over-utilized OR time, and increasing OR efficiency. Status displays had no effect on these end-points, whereas command displays improved the quality of decisions. In the scenarios for which the command displays provided recommendations that adversely affected safety, participants appropriately ignored advice.

CONCLUSIONS: Anesthesia providers and nursing staff made decisions that increased clinical work per unit time in each OR, even when doing so resulted in an increase in over-utilized OR time, higher staffing costs, unpredictable work hours, and/or mandatory overtime. Organizational culture and socialization during clinical training may be a cause. Command displays showed promise in mitigating this tendency. Additional investigations are in our companion paper.

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