Anesth Analg 2009; 108:1249-1256
© 2009 International Anesthesia Research Society
doi: 10.1213/ane.0b013e318195e109
ECONOMICS, EDUCATION, AND POLICY
The Effect of the Operating Room Coordinator's Risk Appreciation on Operating Room Efficiency
Pieter S. Stepaniak, MSc*,
Guido H. H. Mannaerts, MD, PhD ,
Marcel de Quelerij, MD , and
Guus de Vries, PhD
From the *Division of Operating Rooms and Anaesthesiology, Departments of General Surgery, Anesthesiology, St. Franciscus Hospital; and Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Address correspondence and reprint requests to Pieter S. Stepaniak, PO Box 10900, 3004 BA, Rotterdam, The Netherlands. Address e-mail to pieter.stepaniak{at}gmail.com.
Abstract
BACKGROUND: The Operating Room Coordinator (ORC) is responsible for filling gaps in every operating room (OR) schedule. We have observed differences among the personalities of the four ORCs with regard to their willingness to agree to assume more risk concerning their daily planning. The hypothesis to be tested is that the relationship between the personality of each of the four ORCs and the risk an ORC is willing to take of cases running late affects OR efficiency.
METHODS: In order to judge the personality of an ORC in relation to risk-taking in planning schedules, we applied the Zuckerman-Kuhlman Personality Questionnaire in our study. Seven anesthesiologists were asked to score every ORC on willingness to take risks in planning. To analyze which risk attitude creates more OR efficiency, the daily prognosis of the ORC compared with the actual OR program outcome was registered during a 5-mo period in 2006 and 2007. We analyzed whether, in the opinion of hospital management, the costs of reserving too much OR time balances with the costs of reserving too little OR time, and whether this result is consistent with the assignment of the management tasks of the ORC.
RESULTS: Seven anesthesiologists classified the four ORCs into the risk-averse group (n = 2) and the nonrisk-averse group (n = 2). The Zuckerman-Kuhlman Personality Questionnaire results for risk-seeking indicate that there is a difference in risk appreciation among the different ORCs. The main finding in our study is that the nonrisk-averse ORC plans to fill the gaps in more cases in the OR program than the risk-averse ORC does. The number of extra cases performed by the nonrisk-averse ORC as compared to a risk-averse ORC is 188 in 2006 and 174 in 2007.
The average end-of-program-time per OR/day for the nonrisk-averse ORC is 34 min (±19 min, P = 0.0085) later than for the risk-averse ORC. We find that this hospital on average reserves more OR time for procedures than is actually required. The nonrisk-averse ORC takes more advantage of that extra OR time than the risk-averse ORC does by scheduling extra cases during office hours. The success of the nonrisk-averse ORC can be linked to the fact that there is usually time available due to this over-reserving.
CONCLUSIONS: The conclusion of this study is that a nonrisk-averse ORC creates significantly less unused OR capacity without a great chance of running ORs after regular working hours or canceling elective cases scheduled for surgery compared to a risk-averse ORC.
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