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Surgical team operating on patient in theater in hospital

Maximizing operating rooms during the end-of-year elective case rush

Drew Domagalski

Senior Solutions Executive, iQueue for Operating Rooms

Elective surgery case volume trends up and down during the calendar year, and typically follows similar patterns for smaller facilities and large hospital systems. Assessment of an operating room’s utilization throughout all four quarters reveals peaks and valleys of demand. Many pediatric and adult non-urgent, elective procedures often increase during the typical vacation and traveling months. The most dramatic spike in elective surgery case volume often occurs in the remaining fourth quarter of the year, followed by a sharp decline at the start of the new calendar year. The attributing factors to these trends in volume are primarily beyond providers’ control. But providers can manage their resources to meet these changes effectively. 

Perioperative cases surge at the end of every year 

The primary cause of the fourth quarter case volume spike is patient incentives to schedule elective procedures towards the end of the year after meeting insurance deductibles. Procedures delayed earlier in the year become more affordable with met deductibles. Patients are also more likely to have vacation and holiday time off to undergo procedures and take recovery time.  

Once January arrives, however, the demand for surgery abruptly decreases or “throttles”.  The standard payors’ November open enrollment schedule resets deductibles at the start of the calendar year. The most common procedures done in the first few months of the year tend to be time sensitive, while procedures that can be scheduled later will be. For instance, older patients anticipating the need for a hip or knee replacement are much more likely to opt for physical therapy and other affordable, functional tolerance measures until out-of-pocket deductibles are met. 

The impact on providers, and maximizing the operating room for the end-of-year rush

Perioperative providers are challenged by this glut of demand for services that largely stems from payors. They have little or no control over the factors that lead to the operating room end-of-year peak, and no desire to reduce case load given low utilization during other times of the year. The ideal solution to flatten the peak over the entire year is impossible based on the patient’s preference to maximize insurance benefits towards the end of the year.   

The only approach is for providers to adapt to the increase in cases using the constrained staff, rooms, and equipment they have, which post-COVID may be even more limited than usual. Recognizing that the peak is approaching, and having visibility into its details, is key to managing it. 

iQueue for Operating Rooms provides two modules that are especially helpful for maximizing the operating room during the end-of-year peak. The Analyze module provides a historic reference point for key data so that managers can compare where they are in case loads this year compared to previous years. They can also look ahead to what cases are scheduled in upcoming weeks and months, and which service lines and procedures are most active compared to the same dates from the past. Analyze also shows room occupancy and utilization for the past, present, and future. The second module, Exchange, has a more immediate use, showing the ongoing demand signal compared to the available supply, while offering a platform for surgeons and schedulers to immediately release and reserve time as needed. 

All this data together allows perioperative leaders to assess the likely extent of the upcoming peak, compared with the amount of existing resources, including rooms and staffing, they can reasonably expect will be available to accommodate it. This supports informed and adaptive decisions about how many cases to continue booking, how many rooms to operate, how staff need to be assigned, and how schedules should be built. 

In short, the data shows exactly what the OR can expect and the best strategies to maximize its capacity. When facing the inevitable wave of elective cases at the end of the year, ORs can do little to change their circumstances. The best way to accommodate patients is to make the most efficient use of what they do have.

For more on how hospitals and health systems have unlocked the most from their ORs, visit the iQueue for Operating Rooms Resource page.

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