Patient Care

Taking the Guesswork Out of Scheduling Surgeries

By Douglas Page

University of Iowa program uses real-time data to estimate the length of an operation

Much of the guesswork in estimating when a surgery case will end may be alleviated by a new automated system developed at the University of Iowa Carver College of Medicine.

Managers in the university hospital’s 29-bed operating room now use electronic medical data as surgeries are taking place to ease scheduling problems. “We implemented an automatic method to estimate time remaining in surgery cases,” says Franklin Dexter, M.D., director of operations research in the UI anesthesia department.

OR scheduling efficiency has long been one of hospital management’s holy grails. Getting a better fix on the time remaining in ongoing cases is important so OR managers can match staff with workload, decide when to move cases from one OR to another, and know more precisely when to prep the next patient.

Whiteboards that display the status of ongoing cases are notoriously inaccurate in predicting the time remaining in surgery cases. Often, the only option is to ask someone in the OR to make an educated guess about how much longer a surgery will take.

“Our system does not interrupt the surgeon and anesthesia provider, whose jobs are patient care,” Dexter says.

The Iowa program automatically combines patient vital signs collected from the OR with historical data about the surgeon and procedure, then applies the well-known Bayesian probability analysis to generate estimates of the remaining time needed for an ongoing surgery. Updates are made every five minutes, without human input.

Over the years, hospitals have tried various OR management schemes. Massachusetts General Hospital, for instance, currently uses nursing and anesthesia documentation systems, but they are not integrated in real time. According to Warren Sandberg, M.D., an associate professor of anesthesia at MGH and Harvard Medical School, the nursing documentation system updates estimated start and end times once a preceding surgery ends.

“Estimated end time is the product of the OR coordinator’s expertise, experience and vigilance,” Sandberg says.

Additional information on the University of Iowa program can be found online at www.FranklinDexter.com

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