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ECONOMICS AND HEALTH SYSTEMS RESEARCH

Changing Allocations of Operating Room Time From a System Based on Historical Utilization to One Where the Aim is to Schedule as Many Surgical Cases as Possible

Franklin Dexter, MD PhD^*, and Alex Macario, MD MBA

*Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa; Department of Anesthesia, Stanford University, Stanford, California

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

Many facilities allocate operating room (OR) time based on historical utilization of OR time. This assumes that there is a fixed amount of regularly scheduled OR time, called "block time". This "Fixed Hours" system does not apply to many surgical suites in the US. Most facilities make OR time available for all its surgeons’ patients, even if cases are expected to finish after the end of block time. In this setting, OR time should be allocated to maximize OR efficiency, not historical utilization. Then, cases are scheduled either on "Any Workday" (i.e., date chosen by patient and surgeon) or within a reasonable time (e.g., "Four Weeks"). In this study, we used anesthesia billing data from two facilities to study statistical challenges in converting from a Fixed Hours to an Any Workday or Four Weeks patient scheduling system. We report relationships among the number of staffed ORs (i.e., first case of the day starts), length of the regularly scheduled OR workday, OR efficiency, OR staffing cost, and changes in services’ OR allocations. These relationships determine the expected changes in each service’s OR allocation, when a facility using Fixed Hours considers converting to the Any Workday or Four Weeks systems.

IMPLICATIONS: We investigated the complex relationships among the number of surgical services, number of staffed operating rooms (ORs), length of the regularly scheduled OR workday, efficiency of use of OR time, OR staffing cost, and changes in each services’ allocated OR time.

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