The effects of late surgeons on other surgeons, overtime, Pre-Op, PACU, and patient waiting…

SHS2013 poster presentations supported
Below is a simple simulation of the common malady consisting of surgeons who are late for their first case. It’s a good example for other healthcare management engineering problems in that there are many solutions, each with their benefits and drawbacks. There’s a balance among difficulty of initial capital investment, implementation, training, and ongoing cost.
Habitually late surgeons are either unaware of the effects of their tardiness on everyone else…or they don’t care. If unaware, then the following graphs will help clarify the problem. If they don’t care … the solution will be more difficult, but the graphs will help direct other surgeons’ ire to the appropriate cause  (the late surgeon and not the OR staff).
The solution to the congestion in the Pre-Op area can be a combination of any of any of the following: architectural, early starts, late starts, anesthesia technique, nursing algorithm for patient retrieval, surgeon policy for late start time with enforcement provisions, OR scheduling portfolios, sequencing of parts of the surgical process.  Every PreOP solution has an effect on the OR and PACU.
Use the vertical pastels bars (each is 60 minutes wide)  to help compare the two graphs.
Without 2 surgeons’ delays   <click on graphs to enlarge>

PreOp and PACU without surgeon congestion

With  2 surgeons’ delays

PreOp and PACU with surgeon delay

The only changes from the first graph to the second graph are the effects of Surgeons Smith and Green being late 70 minutes and 40 minutes to start their 7am cases.  Notice the repercussions for other surgeons, the OR crew and PACU overtime, and (not visualized) anesthesia.
An increasing case load, or a greater proportion of  short cases, will make the problem worse.

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 Ambulatory Surgical Center, anesthesiologist, ASC, scheduling, similation, surgeon and tagged , , , , , . Bookmark the permalink.

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