Electronic medical records improve operating room scheduling

Mar 8 2009

In the current economic climate, using electronic medical records to lower health care costs is receiving a great deal of attention.

It's a good idea, but, for some specialties, maybe not in the way most people imagine, said Franklin Dexter, M.D., Ph.D., University of Iowa physician and expert in operations research.

Dexter and colleagues have devised a way to use electronic medical data to make inroads into one area of medicine in which it has been notoriously difficult to control costs -- operating room (OR) and anesthesia scheduling. The changes help OR managers better estimate how long a particular case will last, making it easier and more cost-efficient to schedule subsequent cases in the same room.

"It isn't having electronic medical records that reduces costs, but rather how the information from electronic medical records is used," said Dexter, professor of anesthesia at the UI Roy J. and Lucille A. Carver College of Medicine. "In practice, much of the cost reduction is from using electronic medical record data for managerial purposes."

The new system, which Dexter described in the March issue of the journal Anesthesia and Analgesia , combines information about a patient's vital signs in the OR with historical data about how long cases typically last and applies statistical mathematics to provide realistic estimates of the remaining time needed for an on-going OR case. Critically, this information is updated continuously as the case continues -- a process that is currently done manually.

"We have figured out how to do this updating accurately, automatically and electronically without any human input and display that information throughout the surgical suite," Dexter said. "This application can completely change the day–to-day jobs of people who run OR desks."

The data-crunching performed by the system can be augmented by a real-time estimate from the surgical team on the time remaining for the case. The OR staff provide this information in response to an instant message sent by the system that essentially asks, "How much longer?" The response is automatically plugged back into the calculation to improve the accuracy of the time-remaining estimate.

Because every hospital has patient monitoring equipment and an electronic system for tracking historical case-duration information, Dexter suggests that the system he and his colleagues have developed could be easily implemented in any other hospital.

Dexter noted that an important feature of his research, which has spanned more than a decade, has been understanding why it is so difficult to accurately predict how long a surgical case will last, and thus why it is so difficult to efficiently schedule multiple surgeries.

As Dexter explained, the "average" time a case might take is not a very useful number for OR management when scheduling several cases in one OR. At that point, as with a double-header in a sports stadium, it is important to know the longest and the shortest time the first case might run, and to know the probabilities associated with the possible case duration estimates.

"We have figured out how to do this math, and we can do this with only the information in electronic medical records. It's not just that we can say, on average, how long a case will take; we can say there is a 90 percent chance that it will take two hours, for example," Dexter said.

In addition to Dexter, the study team included Richard Epstein, M.D., at Jefferson Medical College in Philadelphia, John Lee, Ph.D., UI professor of mechanical and industrial engineering, and Johannes Ledolter, Ph.D., UI professor of management sciences.