Rational planning of operating lists: a prospective comparison of 'booking to the mean' vs. 'probabilistic case scheduling' in urology.

The efficient use of operating theatres requires accurate case scheduling. One common method is 'booking to the mean'. Here, the mean times for individual operations are summed to approximate the time allocated to the list. An alternative approach is 'probabilistic scheduling'. Here, the means and standard deviation of the individual case times are combined to estimate the probability that the planned list will finish on time. This study assessed how probabilistic booking would have changed list utilisation, over-running and case cancellations in 60 urology lists during eight months that had been 'booked to the mean'. Booking to the mean resulted in 53/60 (88%) lists over-running and correctly predicted the finish times in just 13% of lists. Out of 264 patients, 36 (14%) were cancelled on the day due to over-runs in 24/60 (40%) lists. In contrast, probabilistic scheduling correctly predicted an over-run or under-run in 77% of lists, which would have allowed the case mix to be adjusted to prevent cancellation and optimise utilisation.

Assessing operating room turnover time via the use of mobile application.

BACKGROUND: Improving operating room (OR) utilization is crucial to hospitals. This study examines the effectiveness of a mobile application co-developed with hospital staff to track OR turnover time (TOT). METHODS: An Android-based app, named ORTimer, was used by staff in two OR units (GI-Lab and D-Core) of Greenville Memorial Hospital (GMH) in South Carolina. The staff used the app to record milestones and note delay reasons (if applicable). A total of 1,782 turnover observations from the GI-Lab and 694 turnover observations from the D-Core were collected for the study. Using data collected from the app and additional information from GMH's electronic medical record system, a two-sample proportionality test was conducted to test the hypothesis that the use of the app improved OR turnover performance (i.e., the TOT is equal to or less than the allotted time). RESULTS: The result of the hypothesis test indicates that a higher percentage of observations in the GI-Lab and D-Core met their turnover target time when the ORTimer app was used. Additionally, multiple regression analysis was used to identify significant factors that contribute to prolonged OR TOT and to estimate their impacts. CONCLUSIONS: The app serves as both a visual management tool as well as a TOT data collection tool. By identifying barriers to the on-time completion of the turnaround, the app allows for continuous improvement of the turnover process.

Relationship between physiologic and psychological measures of autonomic activation in operating room teams during a simulated airway emergency.

BACKGROUND: Emotional stability is important for individual and team performance during operating room (OR) emergencies. We compared physiologic and psychological anxiety assessments in OR teams during simulated events. METHODS: Twenty-two teams participated in a "cannot intubate/cannot ventilate" simulation. Participants completed the State-Trait Anxiety Inventory and wore a galvanic skin response (GSR) sensor. Differences in State-Trait Anxiety Inventory scores and GSR levels were analyzed. Anxiety scores were correlated with GSR levels. RESULTS: Resident physicians had significantly higher trait anxiety than the nurses, certified registered nurse anesthetists, and surgical technicians (43.9 ± 9.9 vs 38.3 ± 9.3, P < .01). Senior practitioners had significantly higher trait anxiety than junior practitioners (43.7 ± 9.6 vs 40.0 ± 9.9, P = .03). All groups showed significant increases in GSR. Psychological and physiologic data did not correlate. CONCLUSIONS: Senior practitioners and residents have higher levels of baseline trait anxiety for unclear reasons. Also, OR team training results in physiological signs of anxiety that do not correlate to self-reported psychological measurements.