A behavioral study of daily mean turnover times and first case of the day start tardiness

Jihan Wang; Franklin Dexter; Kai Yang

doi:10.1213/ANE.0b013e3182841226

Previous research has identified 2 psychological biases in operating room (OR) decisions on the day of surgery: risk attitude of the decision-maker at the OR control desk and decisions made by OR staff to increase clinical work per unit time during the hours they are assigned. Resulting decisions are worse than random chance at reducing overutilized time. To isolate the second bias from decisions at the OR control desk, previous studies of the second bias have analyzed decisions made in non-OR locations and on nights/weekends. Another way to isolate the second bias from decisions at the OR control desk is to study facilities with negligible overutilized OR time. We examined the second bias using data from such a facility. One year of data was collected from a 5-OR hospital. Allocated OR time that minimized the inefficiency of use of OR time was determined first to confirm there was virtually no overutilized OR time. A structural equation model was then built to evaluate the relations among variables while controlling for other correlations. We tested the hypothesis that nonoperative times were no longer on days with little versus relatively large workload. The extra ORs were not cost efficient (i.e., the mean potential improvement varied among days from 21.1% ± 0.2% [SE] to 38.9% ± 0.2%), resulting in very little overutilized OR time. However, conditioned on the preceding tactical decision of running extra ORs, the allocated OR time during the studied period was that which minimized the inefficiency of use of OR time. As the preceding results showed that the facility was suitable for the behavioral study, the behavioral study was performed, and the hypothesized relation confirmed. Each 1-hour decrease in the daily estimated (total) duration of elective cases resulted in a managerially unimportant decrease in the mean turnover times (0.41 ± 0.21 minutes, P = 0.053). Excluding turnovers when there were >2 turnovers occurring simultaneously, there was no significant decrease (0.17 ± 0.24 minutes, P = 0.464) in the mean turnover times per each 1-hour decrease in the daily estimated (total) duration. Similarly, after excluding prolonged turnovers (>60 minutes), there was no significant decrease (0.16 ± 0.16 minutes, P = 0.315) in the mean turnover times per each 1-hour decrease in the daily estimated (total) duration. Previous experimental and observational studies found many clinicians maintained high clinical work per unit time during the hours to which they were assigned. We tested and confirmed a prediction of this bias as was applied during regularly scheduled OR hours among an entire surgical team. Overall, the staff worked just as quickly on days with few or many hours of cases. The OR staff did not slow down, thus filling the time. These results have important implications for the cost utility of information technologies to facilitate managerial decision-making on the day of surgery.

A behavioral study of daily mean turnover times and first case of the day start tardiness

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