Caseload Is Increased by Resequencing Cases before and on the Day of Surgery at Ambulatory Surgery Centers Where Initial Patient Recovery Is in Operating Rooms and Cleanup Times Are Longer Than Typical

Caseload Is Increased by Resequencing Cases before and on the Day of Surgery at Ambulatory Surgery Centers Where Initial Patient Recovery Is in Operating Rooms and Cleanup Times Are Longer Than Typical

By
Zhengli Wang, Franklin Dexter, Stefanos Zenios
Journal of Clinical Anesthesia. December
2020, Vol. 67

Study Objective

The coronavirus disease 2019 (COVID-19) pandemic impacts operating room management in regions with high prevalence (e.g., >1.0% of asymptomatic patients testing positive). Cases with aerosol producing procedures are isolated to a few ORs, initial phase I recovery of those patients is in the ORs, and multimodal environmental decontamination applied. We quantified the potential increase in productivity from also resequencing these cases among those two or three ORs.

Design

Computer simulation provided sample sizes requiring >100 years experimentally. Resequencing was limited to changes in the start times of surgeons’ lists of cases.

Setting

Ambulatory surgery center or hospital outpatient department.

Main Results

With case resequencing applied before and on the day of surgery, there were 5.6% and 5.5% more cases per OR per day for the two ORs and three ORs, respectively, both standard errors (SE) < 0.1%. Resequencing cases among ORs to start cases earlier permitted increases in the hours into which cases could be scheduled from 10.5 to 11.0 h, while assuring >90% probability of each OR finishing within the prespecified 12-h shift. Thus, the additional cases were all scheduled before the day of surgery. The greater allocated time also resulted in less overutilized time, a mean of 4.2 min per OR per day for two ORs (SE 0.5) and 6.3 min per OR per day for three ORs (SE 0.4). The benefit could be achieved while limiting application of resequencing to days when the OR with the fewest estimated hours of cases has ≤8 h.

Conclusions

ome ambulatory surgery ORs have unusually long OR times and/or room cleanup times (e.g., infection control efforts because of the pandemic). Resequencing cases before and on the day of surgery should be considered, because moving one or two cases occasionally has little to no cost with substantive benefit.