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March 14, 2017

Exploration of six alternatives nets policy that cuts surgical delay and overtime

By Adam Harringa

Study finds one strategy decreases overtime by 52 percent with same access for patients

A few years back, the Mayo Clinic Division of Colon and Rectal Surgery approached Mayo scientists with a problem: a backlog of patients waiting for surgery. They wanted the scientists, in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, to help them solve the problem.

The center provides research expertise through collaborations such as this to help Mayo's continuous efforts to transform the practice for the welfare of its patients and staff.

The researchers created and simulated six policies that could reduce overtime and improve patient access to care. What’s more, the study showed one policy reduced overtime by 52 percent.

“Overtime is a big concern for hospitals because it is both costly and often associated with dissatisfaction of doctors, nurses and staff,” the researchers wrote in the study, which was published recently in the Journal of Biomedical Informatics. “It is well known that high levels of overtime cause increased staff turnover.”

The researchers said reducing the wait for surgery alleviates other concerns, too, such as patient dissatisfaction.

The paper used five years of data, 2011-2015, from the Division of Colon and Rectal Surgery to simulate appointments based on the current surgical scheduling policy and six alternatives. With the new policies, instead of waiting until the clinic consultation to book a surgery, the scientists propose reserving surgery slots when the consultations are scheduled.

Kalyan Pasupathy, Ph.D.

“Even though we don’t know if the patient is going to have surgery, we pick the surgeon based on their surgical availability,” says Kalyan Pasupathy, Ph.D., associate professor of health care systems engineering and the study’s senior author.

The study found that the best option, which they named “Policy D,” decreased overtime by 52 percent when fine-tuned, and allowed the most urgent cases to be seen sooner. That policy starts by grouping patients by priority level, which accounts for urgency and the patients’ location. Then it calculates the expected surgical workload based on probability of surgery and estimated duration, and reserves slots on the days with the least anticipated workload. Finally, working backward, it uses three options for days between consultation and surgery; one, three and five days, depending on priority.

Mustafa Sir, Ph.D.

“That’s what prioritization is about. Based on medical necessity, we prioritize some patients and we delay others,” says Mustafa Sir, Ph.D., an assistant professor of health care systems engineering and a co-author.

“It’s triaging,” adds Dr. Pasupathy. “We do it in the emergency department all the time. If you go to the ED with chest pain, of course you’re going to be in front of the queue. If you go there with an ankle sprain, you’ll probably wait a lot longer.”

Here are the other five policies:

  • Policy A: Assign the highest priority patients, such as those with colon cancer, to the surgeon with the earliest operating room availability. If there isn’t a slot, reserve a time with the surgeon with the lowest workload within the defined safe time frame and use overtime. For patients at lower priority levels, proceed to the next five policies.
  • Policy B: Assign the patient to a surgeon starting with the last day within the defined safe time frame and work toward the present. This policy defers the surgery of lower priority patients, keeping time slots open for higher priority ones.
  • Policy C: Reserve a time for the patient on the day starting with the least workload, and continue the process from the least busy to busiest day. This policy aims to balance the workload by day in the operating room.
  • Policy E: Follow Policy C, but limit the search for a surgery date to the dates defined by the priority level, keeping earlier dates open for more urgent surgeries. For example, Priority Level 2 patients should not be tentatively scheduled within three business days, which is reserved for Priority Level 1 patients.
  • Policy F: Follow Policy D, but limit the search for a surgery reservation to the dates defined by the priority level.

The Division of Colon and Rectal Surgery, working with the Center's Health Care Systems Engineering team, has begun a pilot program based on the findings. The scientists say the pilot already is working and showing signs of improved access in practice. The pilot is expected to wrap up in March.

“The surgeons’ calendars are like a jigsaw puzzle,” says Dr. Pasupathy. Now, they just need to fit the pieces together.

This research reports the first findings in the study initiated and sponsored by staff in the Division of Colon and Rectal Surgery, including  David Larson, M.D., Colon and Rectal Surgery, and Brian Bernard, who is operations manager for the division.

Tags: Center for the Science of Health Care Delivery, David Larson, Findings, health care systems engineering, Innovations, Kalyan Pasupathy, Mustafa Sir, surgery

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