clinical resolution of systems engineering scheduling in the OR…

No new graphs today…  Let’s discuss the resolution of a systems engineer in improving turnover time (TOT).

In the last few blogs I showed the difference in TOT due solely to who sees the patient in the pre-op holding area, and the sequence of seeing the patient. Depending on random variables, the optimal sequence will vary for each case.  A good team (nurses, anesthesiologist, surgeon) will adapt to these random variables and together choose the most efficient way to get the patient into the room.  Think of an OR team as an American football team: the team members act and adapt to each others needs to get the ball over the goal; each has skills that the others recognize and use together to score points.

There are many of this team’s savings in the OR.  When all the potential time savings are added, they can often cut the TOT in half or more.


1. There must be incentive for the team members to work together.

2. Egos must be left at home, political meetings, the bar…but not brought into the OR.

3. Some people are better at spontaneously organizing than others (give me a mother with 5 kids who are never late for appointments)

4. Some people are better at certain tasks than others

All it takes to increase TOT is for any member of the group to not want to decrease TOT.  It can be hard to detect when a person purposely makes a suboptimal choice, or when that person acts by inaction. (see Caveats)

So, there’s a bottom layer at which a systems engineer can’t affect the TOT, it’s in the hands of the clinical people.  However, above that layer are policies and paradigms used to schedule patients.  I’ll talk about policies and room flipping in another blog.  But for a sample, see a previous blog:   2.7 Million dollars a year. The graph below shows the savings (loss) from TOT after I rescheduled (simulated) the cases following a different paradigm which I’ve used for years.

Total surgeons’ time wasted was more that 55 hours.

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.
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