Scheduling: Optimal Block Schedule, Improving Utilization

Ambulatory surgery centers are distinct from their mixed-use counterparts because the clinical workflow is usually stable and predictable. Ambulatory surgery centers should have a competitive advantage when they are efficiently and effectively managed. Design thinking is an iterative process by which improvement is made to a dynamic system. The optimization of an ambulatory surgery center requires an approach that examines not just each component or constraint, but also considers the local environment, process, stakeholders and barriers as a dynamic system each with stressors and opportunities for improvement. Efficiency and optimization can be reached in each component using traditional metrics; however, if one does not consider the system as a whole, true optimization cannot be achieved.

[1]  Vladimir Marianov,et al.  Scheduling operating rooms with consideration of all resources, post anesthesia beds and emergency surgeries , 2016, Comput. Ind. Eng..

[2]  A. Truong,et al.  Late operating room starts: experience with an education trial , 1996, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[3]  David A. Lubarsky,et al.  A Psychological Basis for Anesthesiologists’ Operating Room Managerial Decision-Making on the Day of Surgery , 2007, Anesthesia and analgesia.

[4]  F. Dexter,et al.  A statistical method for predicting postanesthesia care unit staffing needs. , 1997, AORN journal.

[5]  Mitchell H. Tsai,et al.  Game theory: applications for surgeons and the operating room environment. , 2012, Surgery.

[6]  F. Dexter,et al.  Prospective Trial of Thoracic and Spine Surgeons' Updating of Their Estimated Case Durations at the Start of Cases , 2010, Anesthesia and analgesia.

[7]  Rajender Kumar,et al.  Reasons for cancellation of operation on the day of intended surgery in a multidisciplinary 500 bedded hospital , 2012, Journal of anaesthesiology, clinical pharmacology.

[8]  C. Ko,et al.  The Aging Population and Its Impact on the Surgery Workforce , 2003, Annals of surgery.

[9]  F. Dexter Impact on operating room efficiency of reducing turnover times and anesthesia-controlled times. , 2007, Annals of surgery.

[10]  Franklin Dexter,et al.  Analysis of Strategies to Decrease Postanesthesia Care Unit Costs , 1995 .

[11]  Franklin Dexter,et al.  Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home , 2014, Anesthesia and analgesia.

[12]  A. Mahajan,et al.  A Hospital Is Not Just a Factory, but a Complex Adaptive System—Implications for Perioperative Care , 2017, Anesthesia and analgesia.

[13]  F. Dexter,et al.  Measuring productivity of the phase I postanesthesia care unit. , 1997, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.

[14]  F. Dexter,et al.  An operating room scheduling strategy to maximize the use of operating room block time: computer simulation of patient scheduling and survey of patients' preferences for surgical waiting time. , 1999, Anesthesia and analgesia.

[15]  Rakesh Garg,et al.  Reasons for Cancellation of Cases on the Day of Surgery–A Prospective Study , 2009, Indian journal of anaesthesia.

[16]  Curtis P. McLaughlin,et al.  Factory Focus in Hospital‐owned Ambulatory Surgery , 1992 .

[17]  G. Joshi Efficiency in ambulatory surgery center. , 2008, Current opinion in anaesthesiology.

[18]  F. El-Jardali,et al.  Causes of cancellations on the day of surgery at a Tertiary Teaching Hospital , 2016, BMC Health Services Research.

[19]  S. Rahman,et al.  Theory of constraints , 1998 .

[20]  F. Dexter,et al.  Tactical Increases in Operating Room Block Time for Capacity Planning Should Not Be Based on Utilization , 2008, Anesthesia and analgesia.

[21]  R. Epstein,et al.  The Impact of Service-Specific Staffing, Case Scheduling, Turnovers, and First-Case Starts on Anesthesia Group and Operating Room Productivity: A Tutorial Using Data from an Australian Hospital , 2006, Anesthesia and analgesia.

[22]  Haiyan Wang,et al.  Improving Prediction of Surgery Duration using Operational and Temporal Factors , 2012, AMIA.

[23]  F Dexter,et al.  Statistical Analysis of Postanesthesia Care Unit Staffing at a Surgical Suite with Frequent Delays in Admission from the Operating Room—A Case Study , 2001, Anesthesia and analgesia.

[24]  Yan Xiao,et al.  Making Management Decisions on the Day of Surgery Based on Operating Room Efficiency and Patient Waiting Times , 2004, Anesthesiology.

[25]  J. Ledolter,et al.  Influence of Procedure Classification on Process Variability and Parameter Uncertainty of Surgical Case Durations , 2010, Anesthesia and analgesia.

[26]  E. Shafir The Behavioral Foundations of Public Policy , 2013 .

[27]  F. Dexter,et al.  Influence of the Operating Room Schedule on Tardiness from Scheduled Start Times , 2009, Anesthesia and analgesia.

[28]  D. Tyler,et al.  Determining Optimum Operating Room Utilization , 2003, Anesthesia and analgesia.

[29]  P. Dimitriadis,et al.  The challenge of cancellations on the day of surgery. , 2013, International journal of surgery.

[30]  Wei Li,et al.  Operating Room Planning under Surgery Type and Priority Constraints , 2016 .

[31]  W J Mazzei,et al.  Operating room start times and turnover times in a university hospital. , 1994, Journal of clinical anesthesia.

[32]  Franklin Dexter,et al.  Both Bias and Lack of Knowledge Influence Organizational Focus on First Case of the Day Starts , 2009, Anesthesia and analgesia.

[33]  M. Hawn,et al.  Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement. , 2009, American journal of surgery.

[34]  T. Davis Effective supply chain management , 2020, Strategic Direction.

[35]  James G Wright,et al.  Identification and use of operating room efficiency indicators: the problem of definition. , 2013, Canadian journal of surgery. Journal canadien de chirurgie.

[36]  Gary J. Young,et al.  Hospital competition and financial performance: the effects of ambulatory surgery centers. , 2011, Health economics.

[37]  A. Macario Truth in scheduling: is it possible to accurately predict how long a surgical case will last? , 2009, Anesthesia and analgesia.

[38]  Franklin Dexter,et al.  What can the postanesthesiacare unit manager do to decrease costs in the postanesthesia care unit , 1999 .

[39]  E. Steyerberg,et al.  Predicting the Unpredictable: A New Prediction Model for Operating Room Times Using Individual Characteristics and the Surgeon's Estimate , 2010, Anesthesiology.

[40]  F. Dexter,et al.  Hospital Profitability per Hour of Operating Room Time Can Vary Among Surgeons , 2001, Anesthesia and analgesia.

[41]  A. Vakkuri,et al.  Operating room management: why, how and by whom? , 2008, Acta anaesthesiologica Scandinavica.

[42]  Luis G. Vargas,et al.  Surgical subspecialty block utilization and capacity planning: a minimal cost analysis model. , 1999, Anesthesiology.

[43]  W. Sandberg,et al.  Anesthesiologists and Healthcare Redesign: Time to Team Up with Experts. , 2016, Anesthesiology.

[44]  Anesthesia information management systems: almost there. , 2008, Anesthesia and analgesia.

[45]  René Amalberti,et al.  The paradoxes of almost totally safe transportation systems , 2001 .

[46]  A. Macario Are Your Hospital Operating Rooms “Efficient”?: A Scoring System with Eight Performance Indicators , 2006, Anesthesiology.

[47]  A. Macario What does one minute of operating room time cost? , 2010, Journal of clinical anesthesia.

[48]  L. Fleisher,et al.  Dynamics of Elective Case Cancellation for Inpatient and Outpatient in an Academic Center. , 2013, Journal of anesthesia & clinical research.

[49]  Cost savings in the operating room. , 1998, Anesthesiology.

[50]  J. Ledolter,et al.  Bayesian Prediction Bounds and Comparisons of Operating Room Times Even for Procedures with Few or No Historic Data , 2005, Anesthesiology.

[51]  C. Heij,et al.  Working with a fixed operating room team on consecutive similar cases and the effect on case duration and turnover time. , 2010, Archives of surgery.

[52]  Jesse M. Ehrenfeld,et al.  Operating Room Metrics Score Card—Creating a Prototype for Individualized Feedback , 2014, Journal of Medical Systems.

[53]  Luis G. Vargas,et al.  Modeling the Uncertainty of Surgical Procedure Times: Comparison of Log-normal and Normal Models , 2000, Anesthesiology.

[54]  Shahram Sarkani,et al.  Architecting technology transitions: A sustainability‐oriented sociotechnical approach , 2013, Syst. Eng..

[55]  F. Dexter,et al.  How to Schedule Elective Surgical Cases into Specific Operating Rooms to Maximize the Efficiency of Use of Operating Room Time , 2002, Anesthesia and analgesia.

[56]  A. Macario,et al.  Scheduling of procedures and staff in an ambulatory surgery center. , 2014, Anesthesiology clinics.

[57]  Karl E. Weick,et al.  Managing the unexpected: resilient performance in an age of uncertainty, second edition , 2007 .

[58]  Erik Demeulemeester,et al.  Operating room planning and scheduling: A literature review , 2010, Eur. J. Oper. Res..

[59]  A. Macario,et al.  Setting performance standards for an anesthesia department. , 1998, Journal of clinical anesthesia.