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ECONOMICS, EDUCATION, AND POLICY

Coordination of Appointments for Anesthesia Care Outside of Operating Rooms Using an Enterprise-Wide Scheduling System

Franklin Dexter, MD, PhD^*, Yan Xiao, PhD, Angella J. Dow, BS, Melissa M. Strader, BS^||, Danny Ho, MS^||, and Ruth E. Wachtel, PhD, MBA

From the *Division of Management Consulting, Departments of Anesthesia and Health Management and Policy, University of Iowa, Iowa; Department of Anesthesiology and Program in Trauma, University of Maryland, Baltimore; Department of Anesthesia, University of Iowa, Iowa; Farrell Growth Group, LLC; and ||Department of Anesthesiology, University of Maryland, Baltimore.

Address correspondence 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 or go to web site www.FranklinDexter.net.

Abstract

BACKGROUND: An anesthesia department implemented scheduling of anesthetics outside of operating rooms (non-OR) by clerks and nurses from other departments using its hospital's enterprise-wide scheduling system.

METHODS: Observational studies chronicled the change over 2 yr as non-OR time was allocated by specialty, and nonanesthesia clerks and nurses scheduled anesthesia teams. Experimental studies investigated how tabular and graphical displays affected the scheduling of milestones (e.g., NPO times) and appointments before anesthetics.

RESULTS: Anesthetics performed in allocated time increased progressively from 0% to 75%. Scheduling of anesthetics by nonanesthesia clerks and nurses increased progressively from 0% to 77%. Consistency of patient instructions was improved. The quality of resulting schedules was good. Implementation was not associated with worsening of multiple operational measures of performance such as cancellation rates, turnover times, or complaints. However, schedulers struggled to understand fasting and arrival times of patients, despite using a web site with statistically generated values in tabular formats. Experiments revealed that people ignored their knowledge that anesthetics can start earlier than scheduled. Participants made good decisions with both tabular and graphical displays when scheduling appointments preceding anesthesia.

CONCLUSIONS: Enterprise-wide scheduling can coordinate anesthetics with other appointments on the same date and improve consistency and accuracy of patient instructions customized to the probability of an anesthetic starting early. The usefulness of implementation depends on the value in having more patient-centered care and/or in having patients arrive just in time for non-OR anesthesia, surgery, or regional block placement (e.g., at facilities with limited physical space).

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