predicting scheduled starts for surgery…

also see: Graphic Simulation Interactions of Constraint Theory and Lean

This is getting to be fun.  Now, for a bit of applied constraint theory…

In this simulation we’re considering the surgeon as the most important person…the constraint.  We don’t want him to wait for the case to start, but neither do we want to waste the nurses’ time nor the anesthesiologist’s time waiting on the surgeon.  In a different simulation, we could as easily have chosen the nurses or anesthesia as the constraint (nursing shortage or anesthesia shortage).

Each bar in the following graphs represents a task or event involved in a normal surgical case.  The first graph is a scenario for a surgeon who is normally ready to cut 15 min before the scheduled start of his case.  For him, setting up for the case needs to begin 2 hours before he arrives (note ‘Free Slack’ 2h…the fifth line down):

Now, lets’s make a few changes:

1. A different surgeon is doing essentially the same case; this surgeon usually shows up early and can cut 45 min before start of case,

2. There’s an anesthesiologist who takes an extra 15 minutes to start because he puts in all the patient’s lines before letting the patient prep begin,

3. The patient takes an extra 10 minutes to get into the OR room because she’s being wheeled from the farthest wing of the hospital,

4. And the physician’s assistant for this surgeon always helps prep the patient which cuts off 5 minutes of prep time.

In this scenario, with these alterations, the room setup needs to start  2 hours and 50 minutes before the scheduled start time (5th line down); or 50 minutes earlier than the prior scenario:

About Brian D Gregory MD, MBA

Board Certified Anesthesiologist for 30 years. TOC design and implement for 30 years. MBA from U of Georgia '90: Finance, Data Management, Risk Management. Practiced in multiple US states and Saudi Arabia at KFSH&RC and KFMC Taught residents in two locations. Worked with CRNAs for 20 years.
This entry was posted in anesthesiologist, board of directors, healthcare reform, scheduling, surgeon and tagged , , , , . Bookmark the permalink.

2 Responses to predicting scheduled starts for surgery…

  1. Hi Kian,
    There are a multitude of reasons for late starts. Sometimes you can blame it on a particular person, but even then you need to dig below the surface for the real cause/effect. I prefer the carrot over the stick as a way to get everybody to start on time. Without knowing what type of cases you’re doing, whether your surgeons and anesthesiologists are employed by you, part of a group, or independent entrepreneurs…it’s hard to devise the appropriate carrot. Elsewhere on my weblog I’ve talked about first cases and their relationship to flipping rooms when thinking of what a surgeon really wants from the OR. It may not be an early start, but rather the entire amount of time he’s there to finish all his cases. On my blog you’ve seen parts of my model that shows how all the parts of getting a patient to surgery work together, but that model will show you only how to locate and avoid problems in your current system. It won’t show you the paradigm shift in scheduling that would really improve things. And… most hospital personnel know how to make it look as though someone else is the fault for a late start. The data many facilities collect is often inaccurate or not the correct data needed for improving throughput. It would be more informative if someone who really knows their way around an OR had a look at your particular facility.

    As for Pareto charts…they’re useful as a gross tool. For complicated systems like an OR, they can mislead you in searching for solutions.


  2. Kian Seyed says:

    Hi Brian,

    We at Capital Health are working on the late starts for the 7:30 first cases. Based on the data collected by periop staff and by doing a Pareto chart, surgeons came up first as the main reason for the first cases to start late.

    Any comments?
    I truly appreciate.


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