J. Y. Zhao1, A. Engelman1, O. Plante1, R. Perez1, G. Yang1, P. L. Elkin1, S. D. Schwaitzberg1 1State University Of New York At Buffalo,Surgery,Buffalo, NY, USA
Introduction: Errors in surgical case scheduling can lead to inefficiencies, patient and staff dissatisfaction, and direct and indirect cost burdens to the hospital. Perioperative efficiency is difficult to optimize due to a lack of understanding of the causes behind nonadherence to the surgical schedule. Our study aimed to delineate the points along the perioperative process amenable to targeted interventions to promote scheduling accuracy.
Methods: During a six-month period, a prospective study was performed to evaluate the perioperative process of adult patients undergoing elective surgeries. Patients were directly monitored from registration all the way through to post-anesthesia care. Scheduled times were compared to actual times. Reasons for nonadherence to scheduled times were recorded. Mid-way through the study, attending surgeons began receiving text notifications as soon as their patients were intubated.
Results: A total of 82 surgical cases were observed. Multiple reasons for surgery schedule nonadherence were noted. Most modifiable barriers leading to delays occurred in the preoperative phase; more than half of these barriers could be attributed to organization-related factors. Staffing-related factors were the cause of two-thirds of the delays that occurred once the patient was already in the operating room. Delays preventing patients from leaving the operating room after surgery occurred infrequently, and when they did occur, were most commonly due to a patient-specific reason. After attending surgeons began receiving text notifications that their patient was ready in the operating room, reductions were appreciated in the number of case delays that would have otherwise occurred equal to or less than 30 minutes.
Conclusion: Our prospective time analysis study revealed multiple points in the perioperative process where inefficiencies were introduced and jeopardized adherence to the surgery schedule. Delays beyond thirty minutes will likely occur regardless of how timely an attending surgeon is in arriving to the operation room. Interventions that target organizational and staffing barriers are more likely to be met with success, as patient-specific factors will be less amenable to modifiable intervention.