Tag Archives: anesthesia

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


narration for SHS1013 poster presentations supports  #161 “SHS2013 Clarifying OR On Time Starts” supports #107 “SHS2013 Clarifying OR Turnover Time Concept Graph” supports #113 “Resolving Resistance to OR scheduling changes; Implementing a Multi-faceted Model” also see The effects of late surgeons … Continue reading

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Graphic Simulation Interactions of Constraint Theory and Lean


SHS2013  #107  “Clarifying and Using OR Turnover Time for Purpose and Advantage“ supports #161 “Clarifying the Definition, Purpose, and Effects of OR On-time Starts“ supports #113 “Resolving Resistance to OR scheduling changes; Implementing a Multi-faceted Model“ also see: predicting scheduled starts for … Continue reading

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bad research…or bad reporting?


This is an example of the perils (morbidity, mortality, and financial) of mathematical manipulation of data by researchers in basing broad conclusions without more fully understanding the processes and externalities involved: Unnecessary anesthesia adds $1B to health spending – FierceHealthcare … Continue reading

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increase strategy to increase throughput: …data in context…lean in context…flipped rooms…


Why is this important? It can significantly increase total throughput and throughput as referenced by a particular agent (surgeon, anesthesiologist, hospital). Increased throughput can be converted into large increases in revenue. It can decrease cost for all agents. It can … Continue reading

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the art of flipping rooms…


– There are two main parts to flipping rooms: intra-case and inter-case. They are complementary and work together iteratively. – An analogy of this iterative type of scheduling –adjusting individual cases(intra-case) and schedule (inter-case) to make a good fit– is … Continue reading

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a little data goes a long ways…


Although the expression –‘it’s not what you have, but how you use it’– is not entirely true, knowing how to massage whatever data you have can be very productive.  The data needed for this display is easily available from the … Continue reading

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not your father’s OR scheduler…


Want to know who’s doing what, when: With what?  What’s starting when? Who’s got to be there? How many whos? Can you let a few people off early?  Can you start a few people late?  How many people need to … Continue reading

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labor analysis of CRNA from collectible time data…


6:00 Labor Analysis 482 230 280 0.5809 150 102 14:02 The above shows information about the work of a CRNA during the day. The CRNA clocked in at 6:00 am and out at 14:02 for total Time-on-the-Clock wage minutes of … Continue reading

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OR scheduling concept map (concept diagram)…


A few years ago I diagrammed several concepts involved in scheduling an OR onto this graph.  The intent was to take advantage (or nullify disadvantages) of characteristics of individual surgeons and anesthetists. The interplay of these concepts and individual factors … Continue reading

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putting it all together…intra-case and inter-case….TOT and more


There are a thousand variations of the following examples, but I hope these four graphs will get across some ideas.  For potential economic effects, see:  Wasting $2.7 million dollars a year. Each of the following graphs has 5 bars. Each … Continue reading

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difficulties with start times and TOT in the OR…


The following are excerpts from a discussion concerning Turn-Around-Time (TOT) in the OR.  They relate to my recent posts on scheduling, and show the complexity/difficulty in defining the problems and solving them: ____ she: There are benchmarks out in the … Continue reading

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constraints, risk, and ego in OR start delays… simple example


First off, there must be a 100 different reasons for late OR starts.  Everything from surgeons, anesthesiologist, nurses, equipment, meetings, policies, traffic, school age children and equipment…to a mix of any of the above.  The trick is in understanding the … Continue reading

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TOC in the OR visualized…


Ah….  theory of constraints… This is a visual representation to help with handling constraints in the OR.  For those who use TOC, be aware that the person represented by the green bar (‘Anes MD presence’) could be simultaneously supervising four … Continue reading

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Big Bwana and little bwana…


Everything in the below graph is adjustable (and is derived from less data than is normally collected in an OR). It’s quite useful when deciding how to create your portfolio of surgeons, anesthesiologists, or nurses to limit the short-comings, and … Continue reading

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divide and concur….


Once you visually see the requirements for anesthesia presence during a case, you can also see the potential for saving down-time and better utilizing particular skills when personnel are scarce.   I did leave out the pre-op visit in this … Continue reading

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Typical OR case dissected with details…


These are the relevant milestones and intervals in a typical OR case.  I left off the details so as not to detract from the comparison to the normal representation of an OR case as a single block of time with … Continue reading

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Visual analytics for an OR case…


Visual analytics for an OR case:  Lots of information if you understand the code….   You can tell whether surgery, anesthesia, or the hospital personnel are on top of things and you can compare differences in techniques with resulting effects … Continue reading

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sample requirements for vice-chair of anesthesia department…


Below is a copy of a letter I sent for a position as vice-chair of anesthesia at a large teaching hospital.  I’ve long thought that most vice-chairmen needed to expand their skill sets. . Dear Dr. —-, As you proceed … Continue reading

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new scheduler…timeline and map integration


Operating rooms are expensive assets; you don’t want them sitting idle when people need them. Each room may be equipped differently; you want to schedule procedures in the most appropriate room. To complicate matters, some procedures require special equipment that … Continue reading

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non-expert decison making: perils of democracy…


When making an individual decision, or whether voting as a group, the ‘strength’ of one’s conviction on a topic should be modified by one’s expertise before coming to a final resolution.  All decisions have pros and cons, all of different … Continue reading

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new OR scheduler…


I’ve been experimenting with a new scheduler.  There are many options for visually representing information about OR cases. The scheduler is easily adapted for collecting data to analyze later. The scheduler also has a map view that can include even … Continue reading

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sample new OR scheduler


For all those OR schedulers out there, here’s a new approach.  I left most of the data off on purpose to emphasize the information that the graphics—lines, blocks, fonts, colors, sizes, and proximity— can show.  When in the program, pages … Continue reading

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hold the mayo…


Unfortunately, I forgot to take a picture of my poster presentation at the Mayo Clinic’s 3rd Annual Healthcare Systems Engineering meeting. However, I did take a picture as I was putting it together the week before.  Here it is, in … Continue reading

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understanding visual analytics… and others


What’s wrong with this picture; I see what you mean; I hear where you’re coming from; Something doesn’t feel right: These statements represent analytics. Analytics can be defined as the presentation of input in such a way that it taps … Continue reading

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the law of unintended consequences…staffing anesthesiologists


Value: easily and potentially > than $1,000,000 a year Let’s suppose that a hospital wants fellowship trained anesthesiologists to do all their cases: pediatric anesthesia fellowship for all pediatric cases, neuroanesthesia fellowship for all neuro cases, ob-gyn fellowship for all … Continue reading

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OR throughput, flipping rooms with fast and slow anesthesia…


I found some graphs that I put together a couple of years ago.   The results are born out empirically (at least by my experience in the OR). Lots of information about who to hire, who to fire, who to … Continue reading

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Let sleeping children lie…


While I was at KFSH&RC in Saudi Arabia, a Kiwi friend of mine who was head of the radiation oncology department asked me if my department (anesthesia) could help them expedite their pediatric radiation treatments.  It would take them all … Continue reading

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How to Tell the Productive Surgeons from the non-Productive


The previous blogs were concerned with economic gains for the different parties (surgeon, anesthesia, hospital) by optimizing the relationship each case had with another case (inter-case) — the OR schedule.  Each OR is dramatically different, and what works for one … Continue reading

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communication…life line


With today’s technologies, there are multiple ways for anesthesiologists and surgeons to keep organized and transfer documents while driving in the city, roaming the halls of the hospital, or during a case in the OR.  No one should have to … Continue reading

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