Inpatients Account for Most Canceled Operating Room Time

Earlier Assessment and Statistical Forecasting Could Help Make OR Scheduling More Efficient, Study Suggests

Released: 11-Apr-2014 11:00 AM EDT
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Citations Anesthesia & Analgesia

Newswise — San Francisco, CA. (April 11, 2014) – Hospitalized patients account for at least half of cancelled operating room time, suggests a study published in Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

Late changes to the OR schedule largely result from inpatient cases scheduled within one workday before surgery, suggests the new research, led by Dr Franklin Dexter, Professor and Director of the Division of Management Consulting of the Department of Anesthesia at the University of Iowa, Iowa City. The researchers advocate new strategies to reduce the impact of OR cancellations, such as performing earlier preoperative assessments of hospitalized patients and incorporating "statistical forecasts" into OR scheduling.

Inpatients Account for at Least Half of Canceled OR Minutes
The study was designed to evaluate the reasons for frequent late shifts of operating room schedules—within a day or two before surgery. Late cancellations are a major source of costs and inefficiency in OR scheduling.

The researchers compared cancelled OR time for "inpatients," that is, those who were hospitalized before surgery; versus "outpatients," those who underwent ambulatory surgery (without hospital admission) or were admitted on the day of surgery. The analysis included detailed OR records from 21 non-academic hospitals that were part of a large US health care system, as well as from an academic (university-affiliated) medical center.

In the non-academic hospitals, outpatients accounted for 1.6 percent of scheduled OR minutes that were canceled, compared to 8.1 percent for inpatients. Overall, only about 16 percent of total scheduled OR minutes were for inpatients—yet they accounted for 49 percent of all canceled minutes. At hospitals where inpatients accounted for at least 20 percent of scheduled minutes, they made up 57 percent of canceled minutes.

For outpatients, preoperative clinic visits are commonly recommended to reduce the rate of OR cancellations. However, Dr Dexter and colleagues found that physical clinic visits had little or no impact on canceled OR time for outpatients, compared to preoperative telephone calls.

Call for New Approaches to Improve OR Scheduling Efficiency
At the academic hospital, inpatients accounted for 22 percent of scheduled OR minutes, but 70 percent of canceled OR time. Just over half of total inpatient canceled minutes were from cases scheduled within one workday before surgery. During this period, canceled inpatient minutes were much higher than canceled outpatient minutes.

Understanding the reasons for OR cancellations is important for increasing the efficiency of OR scheduling. This is especially so for late cancellations, which are likely to leave open time that can't be rescheduled.

Dr Dexter and coauthors believe their findings have important implications for efforts to maximize OR efficiency and productivity. The study suggests limited room for improvement in reducing OR cancellations for outpatient surgery. Even with the use of "virtual evaluations" performed by telephone, rather than routine preoperative clinic visits, hospitals can achieve outcome cancellation rates of two percent or less.

Rather, efforts should focus on surgical procedures in inpatients, who account for about half of cancelled OR time, and much more than half at academic hospitals. Performing earlier assessments of inpatients undergoing surgery is one possible approach that should be studied, the researchers suggest.

Given the importance of late cancellations by inpatients, Dr Dexter and colleagues propose that data analysis approaches accounting for the likelihood of late changes should be a routine part of OR scheduling. They write, "[S]cheduling office decision-making within 1 workday before surgery should be based on statistical forecasts that include the risks of cancellation and of inpatient add-on cases being scheduled."

Read the article in Anesthesia & Analgesia

About Anesthesia & Analgesia
Anesthesia & Analgesia was founded in 1922 and was issued bi-monthly until 1980, when it became a monthly publication. A&A is the leading journal for anesthesia clinicians and researchers and includes more than 500 articles annually in all areas related to anesthesia and analgesia, such as cardiovascular anesthesiology, patient safety, anesthetic pharmacology, and pain management. The journal is published on behalf of the IARS by Lippincott Williams & Wilkins (LWW), a division of Wolters Kluwer Health.

About the IARS
The International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through basic research. The IARS contributes nearly $1 million annually to fund anesthesia research; provides a forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of more than 15,000 physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia related practice; sponsors the SmartTots initiative in partnership with the FDA; and publishes the monthly journal Anesthesia & Analgesia in print and online.

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