Constraints on the scheduling of urgent and emergency surgical cases: Surgeon, equipment, and anesthesiologist availability

IntroductionComputer simulation is used to evaluate use of dedicated operating rooms (ORs) for urgent and emergency (add-on) surgical cases versus the same amount of OR time interspersed throughout the day in many ORs and/or at the end of the day. Simulations are limited because of absence of prior quantitative data on the relative incidence of surgeon, equipment, and anesthesiologist availability as a constraint influencing when cases start.MethodsWe prospectively obtained a series of 6 weeks (N=30 days) of add-on cases announced (submitted) in the period 7:30 a.m. through 4:59 p.m. Monday through Friday at an 18 OR Level 1 trauma teaching hospital in The Netherlands. When an urgent or emergency case (add-on) was announced, the OR scheduler evaluated which of the ORs were both clinically suitable for the procedure and either currently open or would be open within 30 min.ResultsThe ratio of mean cases per day with surgeon versus OR availability as a constraint was 96.1% (99% confidence interval 64.6% to 127.8%). The ratio can be considered (in simulation) as equaling 1.0 (P=0.83, mean 1.02±0.10 [SE], median 1.00, N=30 days). The ratios of mean cases each day with equipment as constraint (e.g., C-arm) versus OR availability as a constraint was negligible (mean 0.03±0.02, median 0.00, P<0.0001 relative to 1.0). Lack of an anesthesiologist limiting when the add-on case starts could be neglected entirely (P<0.0001, ratios mean 0.00±0.00, median 0.00).ConclusionsSurgeon and OR availability can be equally (1:1) limiting when cases start. Before individual hospitals apply current papers that are based on ORs being constraints, some hospitals may need also to consider surgeon availability as limiting.