A Dedicated Orthopaedic Trauma Room Increases Operating Room Throughput without Increasing After-Hours Minutes

Abstract

BackgroundThe scheduling and execution of both elective and urgent orthopaedic cases prove challenging for many hospital systems. In this study, we examine the operational and cost efficiency of creating a dedicated orthopaedic trauma (DOTOR) block using operating room management data as a surrogate for financial analyses and decision-making. MethodsUsing WiseOR® (Palo Alto, CA), we extracted the total number of cases, after-hours minutes, opportunity-unused time, and in-block time for the orthopaedic trauma service (OTS) and the dedicated orthopaedic trauma room for the nine months prior to our reallocation of block time (December 2015 – August 2016) and the twenty months after this change (October 2016 – May 2018). Unused elective time was either released to the OR or used to accommodate additional trauma cases. We defined after-hours minutes as the time utilized after 1730 Monday through Friday; opportunity-unused minutes as the time within a block allocation in which a service could have adequately performed another case; and in-block as the time in which a service actively used a block allocation. For each month, we analyzed the data for the orthopaedic traumatologists individually (A, B, C) and for the OTS collectively. Before- and after-implementation data were compared using a two-tailed Student t-test (α=0.05). We calculated the total length of after-hours minutes, in-block time, and caseload for each month spanning from December 2015 to May 2018.1 Pareto optimality was graphically represented using GraphPad Prism (v7.01 La Jolla, CA). ResultsOf 1485 orthopaedic procedures analyzed, 382 occurred before the implementation of the dedicated orthopaedic trauma room, and 1103 cases were performed after the implementation. There was a significant increase in total case volume per month for the surgeons (A & B) who were assigned the additional blocks (32.2 vs 45.4 cases per month, p = 0.0001). There was no significant difference in the total case volume performed by the surgeon (C) whose operating schedule had not changed (10.2 vs. 9.8 cases per month, p = 0.804). There was no significant difference in after-hours minutes per month by the two affected orthopaedic traumatologists (A&B) (1030 min vs. 1180 min, p = 0.452) or by the unaffected traumatologist (C) (8.3 min vs. 16.5 min, p = 0.455). There was no significant difference in opportunity-unused minutes after establishing a DOTOR (2542 min. vs. 2895 min., p = 0.4212). Pareto efficiency for OTS opportunity unused time and after hours minutes per block qualitatively improved (Figure 1). Pareto cost efficiency for after hours minutes qualitatively improved (Figure 2). There was no significant difference in monthly associated after-hours costs ($41,752 vs. $51,722, p = 0.2510). ConclusionsIn this study, we demonstrate that a shift towards the DOTOR system can increase OR efficiency by increasing OR throughput without increasing after-hours minutes. This tactical allocation permitted the orthopaedic traumatologists to meet an increasing need for orthopaedic trauma procedures, both semi-elective and urgent, from a growing health network. Furthermore, with the increase in OR availability, the orthopaedic traumatologists were able to offload a small percentage of cases from our general orthopaedic surgeons, shifting add-on cases performed after-hours to scheduled cases performed by a more efficient team.