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Ask the expert: How should our surgicalist program schedule the OR?

Hospitalist Leadership Connection, December 14, 2010

In many ways, internal medicine hospitalist principles can be translated directly to the surgical hospitalist paradigm. However, surgery differs critically in one regard—the activity in the operating room (OR). As no analogy exists in internal medicine, the management of the OR schedule deserves special attention when implementing a surgical hospitalist program.

How does one choose which OR scheduling model is best for one’s facility? The best method is determined by institution-specific data relevant to the patient population. Consider the following questions related to data:

• What portion of your institution’s OR case volume is a result of unplanned surgical care, such as emergency cases from the emergency department?
• What is the distribution of unplanned cases in terms of acuity and necessity? What percentage are emergent, urgent, or otherwise unplanned?
• What are the comorbities in this patient population (e.g., large-volume blood loss, acute respiratory distress syndrome, chronic lung disease, coronary artery disease, renal failure, or extremes of age)?
• What special resources are required for these cases, and do these unplanned cases then detract from resource availability for elective cases?
• At what time of day do these patients require surgery?
• What is the distribution of these patients over the course of the week?
• How efficient is the OR in managing elective cases? Are data available regarding case duration, based on surgeon and case type, to predict OR use?
• How are the surgical hospitalists to be organized?
• How long is a surgeon’s shift?
• Is operating at 2 a.m. handled by the OR in nearly the same way as operating at 2 p.m.?
• Does one surgeon work primarily daytime hours but cover the evening hours from off site with the assumption that not as much work goes on?
• How efficient are the surgical hospitalists?
• If the surgical hospitalist estimates that the case will last 90 minutes, is the estimate reliable?
• Does the case usually run overtime, thus making the OR manager hesitant to open slots between elective cases?
• If the average laparoscopic appendectomy at the hospital takes 30 minutes, does the surgical hospitalist take 20 or 60 minutes?

All of these independent factors influence what model is best suited to a particular institution to maximize unplanned surgical patient care.

The above excerpt is adapted from The Surgical Hospitalist Program Management Guide: Tools and Strategies for Executives and Physicians, by John Nelson, MD, FACP; John Maa, MD, FACS; and foreword by Robert M. Wachter, MD, published by HCPro, Inc. Download a free sample chapter online at www.HCMarketplace.com.

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