In our current surgical system blocks of OR time are assigned to surgeons in which patients are booked from the surgeon’s office based on time available and time required for the particular procedure. These blocks might be either half-day or full day blocks, and the assignment of blocks usually would be established at time of recruitment of the surgeon with evolution as the surgeon’s seniority progressed. The surgeon would then build their ambulatory office or clinic time around their OR time. Hence making adjustments to OR days and time is complex within surgical services, with impacts on clinic and office utilization, unit staffing and schedules, impacts on the schedules of other surgeons, impacts on anaesthesiology schedules, and impacts on OR staffing among other factors. All of this leads to deep entrenchment of OR days and times. Few surgeons relish OR time at the end of the week for a variety of reasons. The result has been a strong tendency to bunch up cases in mid-week on the OR lists.
This ‘bunching’ effect predictably increases pressures on patient flow during mid-week days with increased utilization of ward beds and ICU beds which in turn affects the ED and other services across the hospital. Surgical services have managed their own needs within surgical units by staffing up mid-week and staffing down on the weekend and shoulder days within surgical services. However in the healthcare system in which we work, bed occupancy is close to 100% in “non-surge” seasons and most often is in excess of 100% in “surge” seasons (November through April). As such, there is minimal flexibility to manage the mid-week surgical peaks, and patient flow is negatively impacted.
“Smoothing out” the surgical schedule has been challenging for different administrations and medical leadership over the years, however we are now prepared to have a fresh look at the issues underlying the problem and seek new approaches.