## Getting Dr. Able out of the OR before 4pm…

narration for SHS1013 poster presentations

supports  #161 SHS2013 Clarifying OR On Time Starts

supports #107SHS2013 Clarifying OR Turnover Time Concept Graph

A progression of techniques…

Dr. Able has two cases following two surgeons in the room ‘Multiple’.  He has to be finished by 16:00 to take call; if not, the hospital says that he will have to get a partner to cover call.

Baseline…Room setup of first case in room ‘Multiple’ begins at 7am with Dr. Smith.  Dr. Able finishes at 18:17

Graph 1

Surgeon starts at 7am for 95% surgical start at 7am…  Dr. Smith has wanted a 95% guarantee of a 7am surgical start.  Unfortunately for him, the OR will not let the nurses clock in before 6:00.  By the time the nurses have changed into scrubs and arrived at the room, it’s 06:18.  Dr. Smith keeps records of his start times, and has calculated that for a 95% chance of being ready to cut, he should show up at 07:25 [67 minutes later] which he does. Dr Jones starts 43 minutes earlier than in Graph 1. Dr. Able finishes at 17:35.

Graph 2

Surgeon starts earlier than 7am because the room and patient are usually ready earlier for a 95% surgical start at 7am… Dr. Smith sees the gantt chart and realizes how much sooner he can usually finish if he arrives earlier. He buys a faster car and arrives at the hospital before the time the room and patient are ready, 50% of the time being before 06:43 [42 minutes (67-25) earlier than before].  With the saved time, the nurses and anesthetist start Dr. Jones’ case 42 minutes earlier than in Graph 2. Dr. Able finishes at 16:53

Graph 3

Dr. Able flips his last room into one of the two rooms which Dr. Schlicter had been using… Dr. Able finishes [90 minutes earlier than in Graph 3] at 15:23… and does not need to get a partner.

Graph 4

Comment on Graph 2

You may have noticed that in Graph 2 the OR crew perceives Dr. Smith as arriving 17 minutes late for his 7am start for half of his cases. Dr. Smith, however, perceives that the OR nurses are incompetent since they occasionally make him wait  if he shows up before 7:20.  With the nurses’ inability to clock in before 6am, and Dr. Smith not showing up by 7am, the OR crew probably feels angry and disrespected by complaints from the surgeon to administration about the late starts.

## 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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