| Description |
- OBJECTIVE: To evaluate the effect of surgical case sequencing on patient flow delays considering downstream hospital resources.
BACKGROUND: Operating Rooms (OR) are often constrained by downstream resources, which affect patient flow and surgeon productivity. As ORs are expensive and resource intensive, it is imperative to prevent delays such as OR and Post Anesthesia Care Unit (PACU) holds. Discrete event simulation (DES) has been used to model operating room flow; however, these models often conflate system and physiological factors affecting patient flow delays. We propose the use of alternative inputs into DES to inform how case sequencing and turnover time affects PACU and OR holds and attribute these holds to patient or system factors.
METHODS: Using DES, we analyzed the effect of case sequencing practices and turnover time on the occurrence and severity of OR and PACU holds. We constructed a DES of a tertiary university hospital using EHR case data from 2023-2024, considering downstream flow constraints (ICU, PACU, Inpatient Beds).
RESULTS: By changing daily case sequencing practices to an “outpatient first” policy, OR holds can be reduced by 72% and PACU holds can be reduced by 21%. Furthermore, we show the counterintuitive result that decreasing turnover time can increase hold times.
CONCLUSIONS: A DES model can reliably provide insight into the effect that downstream resource considerations can have on OR and PACU holds. It is particularly useful in systems operating under constrained resources. We are currently investigating a pilot of these sequencing practices within our hospital system.
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