title: Lack of value of scheduling processes to move cases from a heavily used main campus to other facilities within a health care system.
abstract: BACKGROUND
  Economically, the most important anesthesia group and operating room (OR) management decision is the choice made months before surgery of the allocated OR time (duration of the workday) for each service. Consider a health system with surgeons who practice at multiple hospitals and ambulatory surgery centers. The main campus' ORs are busy, with nearly 8 h of cases, including turnovers, per anesthetizing location per workday. The other (regional) facilities have substantial underutilized time. A surgeon wants to do one 3-hour case at the main campus and have an afternoon start. The anesthesia group's OR director could use the health systems' common OR information system to examine the surgeons' schedules at all facilities. In this study, we quantify the percentage of OR hours that can practically be off-loaded from a main campus with long duration workdays.
  
  
  METHODS
  One year of cases were evaluated from a health system with a busy main campus, multiple (11) regional facilities with low workload per OR per day, and a common OR information system.
  
  
  RESULTS
  The OR time was summed among surgeons meeting the following criteria: no first case start at the main campus that day; performing <4 hour of elective cases at the main campus that day; and doing at least 1 case at any of the regional facilities within the preceding or following week. The OR time potentially moveable was <0.8% (95% CI, 0.7% to 0.8%) of the total OR time used by all surgeons operating at the main campus, considerably less than the managerially important threshold of "≥ 5.0%" (P < 0.0001). The principal reason for the result was that few (10%) OR hours at the main campus were used by surgeons performing <4 hour of cases that day. To understand why so little OR time could be moved, we performed secondary analysis of different data from 21 facilities nationwide. Larger hours of cases per OR per workday (e.g., 7.8 hour at the main facility) were commonly associated with larger percentages of workdays for which single surgeons filled an OR for the day (r = 0.87 ± 0.05).
  
  
  CONCLUSIONS
  For many health systems, investing in the software and personnel to coordinate case scheduling among facilities is unlikely to be of benefit, either operationally or financially.
authors.affiliation: Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Louise
authors.initials: L
authors.lastname: Sulecki
authors.forename: Franklin
authors.initials: F
authors.lastname: Dexter
authors.forename: Andrew
authors.initials: A
authors.lastname: Zura
authors.forename: Leif
authors.initials: L
authors.lastname: Saager
authors.forename: Richard H
authors.initials: RH
authors.lastname: Epstein
mesh_terms: D000761:Anesthesia Department, Hospital / Q000191:economics / Q000458:organization & administration*; D001071:Appointments and Schedules; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D017598:Efficiency, Organizational; D017558:Elective Surgical Procedures / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D016018:Least-Squares Analysis; D009870:Operating Room Information Systems / Q000191:economics / Q000458:organization & administration*; D009873:Operating Rooms / Q000191:economics / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000458:organization & administration*; D010562:Personnel Staffing and Scheduling Information Systems / Q000191:economics / Q000458:organization & administration*; D013997:Time Factors; D017748:Time Management; D016526:Workload / Q000191:economics