Assessing The Process of the Operating Room at VA Connecticut

Tan P. Pham, Yale University
Jill Wellner, VA Connecticut Healthcare System

Abstract

Executive Summary

We extracted medical records from the Vista Surgical Package for Fiscal Year 2011 (FY’11) and parts of Fiscal Year 2012 (October 2011-Janurary 2012). The data was validated during the months of December 2011 and January 2012 through manual observations. For this report, the data was restricted to Fiscal Year 2011 (October 2010-September 2011). We have a total of 3004 surgeries completed during FY’11.

Delays were calculated by taking the differences in minutes between the time the patient enters the operating room and the time the surgery was scheduled. Only elective and urgent completed surgeries were included in the analyses. Surgeries by Urology and emergent surgeries were excluded from the analyses.

We found that the first case of the day were typically on time (median=0 minutes), but have a mean average of 19 minutes of delay. After the first case, the mean delay time doubled for the second case (42 minutes). We observed the most delays occurred on Tuesdays (25%), Thursdays (24%), Friday (24%) and surgeries scheduled between 12:00 PM and 3:00 PM. Residents were more likely to have a delayed surgery when compared to Attendings. Anesthesiology (69%) and Ocular Plastics (57%) had the highest proportion of delayed cases. Thoracic surgery (49 minutes) had the highest mean delay time.

We examined the utilization of operating rooms as a possible factor for surgical delays by comparing the time allotted for each specialty service (OR Block Time) with the actual utilization for each specialty service. We identified specialty services that were under and over utilized. Four specialties were required more allotted OR time (over-utilized): Neurosurgery, Ocular Plastics, Ophthalmology and Podiatry, while all other specialties were under-utilized. Currently, there is no schedule standard for scheduling surgical cases. We compared the number of scheduled minutes with the number of utilized minutes for each specialty. We noted that Neurosurgery, Orthopedics, Otorhinolaryngology (ENT), Plastics, Thoracic and Urology typically did not have enough scheduled minutes to complete the surgery.

We used two data sources to estimate the cost associated with surgical delays. For Surgeons, we obtained annual salary data from the Association of American Medical College 2010 Salary Survey. For surgical support staff, we obtained the average salary of each type (Registered Nurses, Nurse Anesthetist..etc) of support staff from VACT from the Payroll Office. We calculated the cost per minute for both groups using the data sources and including a 30% fringe benefit cost. For fiscal year 2011, there were a total of 72,767 delay minutes (4.85 hours a day). The total delay cost for fiscal year 2011 was estimated to be $1,381,746. For overtime cost, we obtained all overtime paid records for the months of January 2012 and February 2012. We averaged the two months to calculate the average overtime cost per month. We found for the two months, VACT paid $8,103.68 in overtime.