Which algorithm for scheduling add-on elective cases maximizes operating room utilization? Use of bin packing algorithms and fuzzy constraints in operating room management. (1/23)

BACKGROUND: The algorithm to schedule add-on elective cases that maximizes operating room (OR) suite utilization is unknown. The goal of this study was to use computer simulation to evaluate 10 scheduling algorithms described in the management sciences literature to determine their relative performance at scheduling as many hours of add-on elective cases as possible into open OR time. METHODS: From a surgical services information system for two separate surgical suites, the authors collected these data: (1) hours of open OR time available for add-on cases in each OR each day and (2) duration of each add-on case. These empirical data were used in computer simulations of case scheduling to compare algorithms appropriate for "variable-sized bin packing with bounded space." "Variable size" refers to differing amounts of open time in each "bin," or OR. The end point of the simulations was OR utilization (time an OR was used divided by the time the OR was available). RESULTS: Each day there were 0.24 +/- 0.11 and 0.28 +/- 0.23 simulated cases (mean +/- SD) scheduled to each OR in each of the two surgical suites. The algorithm that maximized OR utilization, Best Fit Descending with fuzzy constraints, achieved OR utilizations 4% larger than the algorithm with poorest performance. CONCLUSIONS: We identified the algorithm for scheduling add-on elective cases that maximizes OR utilization for surgical suites that usually have zero or one add-on elective case in each OR. The ease of implementation of the algorithm, either manually or in an OR information system, needs to be studied.  (+info)

Forecasting surgical groups' total hours of elective cases for allocation of block time: application of time series analysis to operating room management. (2/23)

BACKGROUND: Allocation of the correct amount of operating room (OR) "block time" can provide surgeons with access to sufficient OR time to complete their elective cases while optimally matching staffing with the elective case workload (to maximize labor productivity). To evaluate how to predict accurately total hours of elective cases performed by a surgical group using data from surgical services information systems, the authors addressed the following questions: (1) How many previous 4-week periods of data should be used to minimize error in forecasting a surgical group's total hours of elective cases? (2) Using the number of 4-week periods from question #1, can we detect trends or correlations between successive periods that could be used to improve forecasting accuracy? (3) How can results from questions #1 and #2 be used to calculate an upper prediction bound (upper limit) for the total hours of elective cases that will be completed in a future period? Prediction bounds can be used to budget staffing accurately. METHODS: Time series analysis was performed on total hours of elective cases over 39 consecutive 4-week periods from 17 surgical groups. RESULTS: The average of 12 consecutive periods' total hours of elective cases had an appropriate error profile. The observations within each series of 12 consecutive 4-week periods followed a normal distribution, with each observation of total hours of elective cases not correlated with the subsequent observation. CONCLUSIONS: The average of the most recent 12 4-week periods can be used to predict surgical groups' future use of block time.  (+info)

Real-time Internet connections: implications for surgical decision making in laparoscopy. (3/23)

OBJECTIVE: To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. SUMMARY BACKGROUND DATA: Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. METHODS: Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were "grabbed" from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. RESULTS: The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. CONCLUSIONS: Low-bandwidth, Internet-based telemedicine is inexpensive, effective, and almost ubiquitous. Use of these inexpensive, portable technologies will allow sharing of surgical procedures and decisions regardless of location. Internet telemedicine consistently supported real-time intraoperative consultation in laparoscopic surgery. The implications are broad with respect to quality improvement and diffusion of knowledge as well as for basic consultation.  (+info)

Large public display boards: a case study of an OR board and design implications. (4/23)

A compelling reason for studying artifacts in collaborative work is to inform design. We present a case study of a public display board (12 ft by 4 ft) in a Level-I trauma center operating room (OR) unit. The board has evolved into a sophisticated coordination tool for clinicians and supporting personnel. This paper draws on study findings about how the OR board is used and organizes the findings into three areas: (1) visual and physical properties of the board that are exploited for collaboration, (2) purposes the board was configured to serve, and (3) types of physical and perceptual interaction with the board. Findings and implications related to layout, size, flexibility, task management, problem-solving, resourcing, shared awareness, and communication are discussed in an effort to propose guidelines to facilitate the design of electronic, computer driven display boards in the OR environment.  (+info)

Coordination challenges in operating-room management: an in-depth field study. (5/23)

Dynamic settings possess complex information needs all requiring attention in order to be managed effectively. The following study describes the multi-faceted information exchanges essential for an operating room suite to be managed within the context of efficient, cost effective, safe practice. Through the combined use of observation, the Critical Incident Technique, and interviews, this study analyzed information issues that impact coordination. Results demonstrate how distributed team planning is inherent to the efficacy of the system, and discuss implications for information tools to support coordination within in a complex setting.  (+info)

Estimating the incidence of prolonged turnover times and delays by time of day. (6/23)

BACKGROUND: Prolonged turnover times cause frustration and can thereby reduce professional satisfaction and the workload surgeons bring to a hospital. METHODS: The authors analyzed 1 yr of operating room information system data from two academic, tertiary hospitals and Monte-Carlo simulations of a 15-operating room hospital surgical suite. RESULTS: Confidence interval widths for the mean turnover times at the hospitals were negligible when compared with the variation in sample mean turnover times among 31 hospitals. The authors developed a statistical method to estimate the proportion of all turnovers that were prolonged (> 15 min beyond mean) and that occurred during specified hours of the day. Confidence intervals for the proportions corrected for the effect of multiple comparisons. Statistical assumptions were satisfied at the two studied hospitals. The confidence intervals achieved family-wise type I error rates accurate to within 0.5% when applied to between five and nineteen 4-week periods of data. The diurnal pattern in the proportions of all turnovers that were prolonged provided different, more managerially relevant information than the time course throughout the day in the percentage of turnovers at each hour that were prolonged. CONCLUSIONS: Benchmarking sample mean turnover times among hospitals, without the use of confidence intervals, can be valid and useful. The authors successfully developed and validated a statistical method to estimate the percentage of turnover times at a surgical suite that are prolonged and occur at specified times of the day. Managers can target their quality improvement efforts on times of the day with the largest percentages of prolonged turnovers.  (+info)

Usability factors in the organization and display of disparate information sources in the operative environment. (7/23)

The integration and presentation of information from a number of disparate sources in the operative environment raises a number of usability and human factors challenges. Through a collaborative effort, a display combining persistent and dynamically switching panes provides a rich source of information to help orient team members, provide indications of case progress, and organize information into stage-based tabbed panes. This provides maximal flexibility within visibility and usability constraints.  (+info)

Integration of hospital information systems, operative and peri-operative information systems, and operative equipment into a single information display. (8/23)

The integration of disparate information systems in the operative environment allows access to information that is typically unseen or unused. Through a collaborative effort, a variety of information systems and surgical equipment are being integrated. This provides improved context-sensitive information display and decision support and improved access to information to improve workflow, safety and visualization of information that was previously unattainable.  (+info)