Managing surgical wait times in the intra-COVID 19 world part 2: developing surgical scheduling 

As operating rooms continue to work through case backlogs, both previously accrued and continuing to accumulate due to ongoing COVID surges, having a tailored system to prioritize and schedule those cases is more important than ever. A previous post covered various case prioritization models and what perioperative leadership should consider when choosing one. But for truly effective surgical scheduling, case priority must be balanced with other factors. 

Surgical staffing and case backlog volume will vary widely among service lines and can impact how cases are best scheduled. Additionally, perioperative leaders should not ignore wait times when many patients are already experiencing extended delays for deferred procedures. 

Incorporating surgical case prioritization with other considerations

When determining how to prioritize backlogged cases in surgical scheduling, consider using a prioritization model that incorporates patients wait times in addition to case urgency and/or complexity. Several models exist that weight various factors differently in their priorities. The American Surgical Association’s MultiFactor model, for instance, mixes subjective and objective scores to produce a final priority score. Any of these models, chosen to best suit the organization’s needs, allow service lines with significant backlogs but only low to medium priority cases, such as orthopedic procedures that impact quality of life, to still begin to work through their backlog in a timely manner. 

Additionally, it is important to holistically consider each surgeon’s backlog when prioritizing cases. It may be more efficient to use a prioritization model that grants surgeons half or whole day surgical blocks to work through cases, rather than scheduling one-off cases sporadically. 

Backlogs also continue to evolve over time. By evaluating backlogs on a weekly or bi-weekly cadence, perioperative leaders can ensure they are responding to the most updated demand and adjusting appropriately.

Incorporating all the considerations above is extremely challenging to accomplish using any manual process. Fortunately, hospitals can use additional AI-based tools to develop a data-driven approach for working through their backlogs. 

Building an adaptable surgical schedule on priority, surgical wait times, and available OR time

Hospitals should consider leveraging technology in several ways to ensure they are managing their backlogs through strategic surgical scheduling as effectively as possible.

Backlog tracking: Before it is possible to prioritize backlogged cases, perioperative leadership must first understand which cases constitute their backlog. Using technology, hospitals can quickly see which surgeons have backlogged cases, how long patients have been waiting, and how urgent each case is.

Allocation of OR time: Once hospitals understand which cases constitute their backlog, they can then holistically evaluate how to schedule cases. The early-phase allocation mode LeanTaaS is developing uses an algorithm that incorporates multiple factors for each case to determine a recommendation for allocating OR block time to surgeons. When using this tool, hospitals have been able to temporarily suspend their surgical block schedule and shift to allocating time based on the algorithm’s recommendations on a weekly or bi-weekly basis.

While many hospitals may attempt to determine an ad hoc block allocation manually, it is impossible to accurately incorporate multiple important factors in the same way that a sophisticated algorithm can. By using a data-driven approach to allocate OR time when working through the case backlog, perioperative leadership can consider:

• Case priority and urgency
• Patient wait times
• Expected case durations 
• Available OR time
• Surgeon’s preferred day of week
• Historical data (to predict additional cases that will likely be added to the backlog in the future)

An algorithmic tool can take the recommended block allocation one step further by recommending specific cases that should be completed during each allocated block. This further takes the guesswork out of managing OR time while working through the backlog. Perioperative leadership can rest assured that they are assigning OR time in a way that balances a wide range of complex factors.

Conclusion: 

Working through surgical backlogs, especially as new elective cases build up, will continue to be a critical part of navigating and recovering from surges of COVID infections. Developing a data-driven strategy for tracking case backlogs and subsequently assigning OR time in a nuanced manner is necessary to ensure cases are assigned appropriately. The successful adoption of this prioritization and scheduling system during a crisis will continue yielding greater efficiency, surgeon satisfaction, and patient outcomes in “peacetime” as well. 

For more information on technology available to support a strategically prioritized surgical schedule, visit the iQueue for Operating Rooms Resources page.