L. H. Stevens1,2, N. Walke2, J. Hobbs2, T. Bell1, K. Boustany2, B. Zarzaur1 1IU School Of Medicine,General Surgery,Indianapolis, IN, USA 2IU Health,Perioperative Services,Indianapolis, IN, USA
Introduction:
~~Efficient usage of the operating rooms is crucial to a hospital’s mission and survival. Traditionally the allocation of operating room (OR) block time to surgeons has been heavily influenced by historical usage patterns (which may no longer be relevant), local politics and organizational culture instead of data driven analysis of the most efficient OR allocation. We created a computerized simulation model of the OR’s to drive more rationale and efficient utilization. This model provides the ability to test proposed changes in block allocation, demonstrate the impact of those changes to the surgeons, and thus gain surgeons’ buy-in to the proposed changes before implementation.
Methods:
~~A discrete-event, adaptive, complex system computerized simulation model was created based on big-data analysis of 3 years of historical OR data and an industrial engineering work-flow analysis of a 600-bed level-1 trauma hospital with 30 operating rooms. Data elements included: admission type, case urgency, number of cases by surgical specialty, equipment utilized, case duration, personnel required, and patient flow within the perioperative department (from patient check-in to discharge from the recovery room). The simulator provides the ability to model changes in OR block allocation by the full day or half day, create specialty specific blocks, open OR blocks as “first-come first-served,” set aside OR blocks for urgent or emergent cases, and/or to close OR blocks and then measure the impact of these changes on OR utilization and throughput. The simulator provides the ability to test up to 8 different block allocation scenarios at a time and runs each scenario 10 times to assess the total & mean OR utilization over a month.
Results:
~~Using actual O.R. case volumes, case urgencies, and specialty mix the simulator was used to contrast the O.R. utilization achieved by the historical specialty based OR block allocation (scenario #1) with total elimination of all specialty block allocation, making every OR open for elective scheduling on a “first-come, first served” basis (scenario #2). Having all OR’s open for “first-come, first-served” scheduling resulted in significantly higher total and mean OR utilization (Total OR utilization scenario 1= 2,051.9 hours vs. scenario 2=2,236.4, p=0.02; mean OR utilization scenario 1=68.4% vs. scenario 2=74.5%, p=0.02).
Conclusion:
~~The usage of a computerized simulator of the OR’s provides surgical leaders with a virtual laboratory to test experimental OR allocation scenarios that can increase OR utilization but would be far too radical to implement without the surgeons’ buy-in. Surgeon buy-in and implementation of new approaches to OR allocation are enhanced by this data driven approach.