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ECONOMICS, EDUCATION, AND POLICY

Both Bias and Lack of Knowledge Influence Organizational Focus on First Case of the Day Starts

Elisabeth U. Dexter, MD, FACS^*, Franklin Dexter, MD, PhD, Danielle Masursky, PhD, Michael P. Garver, MSEE, and Nancy A. Nussmeier, MD

From the *Section of General Thoracic Surgery, Department of Surgery, State University of New York [SUNY] Upstate Medical University, Syracuse, New York; Division of Management Consulting, Departments of Anesthesia and Health Management and Policy, University of Iowa, Iowa; Department of Anesthesiology, SUNY Upstate; and Materials Management, SUNY Upstate, New York.

Address correspondence and reprint requests 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 web site www.FranklinDexter.net.

Abstract

BACKGROUND: The economic costs of reducing first case delays are often high, because efforts need to be applied to multiple operating rooms (ORs) simultaneously. Nevertheless, delays in starting first cases of the day are a common topic in OR committee meetings.

METHODS: We added three scientific questions to a 24 question online, anonymous survey performed before the implementation of a new OR information system. The 57 respondents cared sufficiently about OR management at the United States teaching hospital to complete all questions.

RESULTS: The survey revealed reasons why personnel may focus on the small reductions in nonoperative time achievable by reducing tardiness in first cases of the day. (A) Respondents lacked knowledge about principles in reducing over-utilized OR time to increase OR efficiency, based on their answering the relevant question correctly at a rate no different from guessing at random. Those results differed from prior findings of responses at a rate worse than random, resulting from a bias on the day of surgery of making decisions that increase clinical work per unit time. (B) Most respondents falsely believed that a 10 min delay at the start of the day causes subsequent cases to start at least 10 min late (P < 0.0001 versus random chance). (C) Most respondents did not know that cases often take less time than scheduled (P = 0.008 versus chance). No one who demonstrated knowledge (C) about cases sometimes taking less time than scheduled applied that information to their response to (B) regarding cases starting late (P = 0.0002).

CONCLUSIONS: Knowledge of OR efficiency was low among the respondents working in ORs. Nevertheless, the apparent absence of bias shows that education may influence behavior. In contrast, presence of bias on matters of tardiness of start times shows that education may be of no benefit. As the latter results match findings of previous studies of scheduling decisions, interventions to reduce patient and surgeon waiting from start times may depend principally on the application of automation to guide decision-making.

This article has been cited by other articles:

				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]

				F. Dexter and R. H. Epstein Typical Savings from Each Minute Reduction in Tardy First Case of the Day Starts Anesth. Analg., April 1, 2009; 108(4): 1262 - 1267. [Abstract] [Full Text] [PDF]