Operations Management for clinics, hospitals, and surgical services represents multiple challenges with regards to managing patient flow and delivering services in a punctual, cost-sensitive manner. One important challenge that has gained interest in the press concerns the practice of double-booking surgeries. As the title indicates, double-booked surgeries relates to the practice in which an attending surgeon, and potentially an attending anesthesiologist, is assigned to multiple surgeries throughout the same time-slot. In this way, the senior surgeon will usually perform the major or most difficult parts of the surgery, leaving the routine portions to physicians-in-training, e.g. residents and/or fellows. Largely, the process of double-booking surgeries is treated as a means for education and training. Less experienced physicians are able to observe experts in the field, while also performing crucial surgical tasks that will be important for their later clinical responsibilities as full-time, attending physicians. Yet, there are also potential concerns with the practice as explored in the literature, predominantly that double-booked surgeries may incur a risk to the patient, in addition to the logistical difficulties of execution from the operations management view. This article will ascertain the challenges associated with double-booking surgeries for anesthesiologists and practice managers, while also detailing the impact to patient safety and patient populations.
The practice of double-booking surgeries, while frequent at many hospitals, can create a serious administrative challenge for managers. Double-booking surgeries necessitates a high degree of coordination at the micro level. Surgeons must identify which elements of the surgery are most complex to perform, and smoothly communicate these recommendations to operating room (OR) managers, who then slot the surgeries in certain OR rooms and with associated staff, including anesthesiologists. For attending anesthesiologists and anesthesia staff, the instance of a surgeon moving from room to room can create a distraction.
Specifically, one potential side effect of double-booking surgeries is the ability to induce tardiness. Tardiness can lead to OR delays,
result in anesthesiologists and anesthesia staff working additional hours, and causing an unnecessary economic burden to the hospital
Allen et al calculated the impact of tardiness on surgical service healthcare institutions in the Journal of Healthcare Management1. The researchers concluded that each lost minute in the OR was valued at approximately $9.56 in associated costs. In an intervention condition that addressed delayed surgical start times, many of which were associated with double-booked surgeries, cost savings resulted in over $700,000 to the hospital. Hence, if not executed carefully, double-booked surgeries may result in a significant economic burden for the hospital.
Along with the cost impact of double-booked surgeries, patient safety is a significant cause for concern. Given that double booking surgeries requires multiple transitions during the operation, in addition to the condition that surgeon trainees may then perform a majority of the surgery, several thought leaders have questioned whether there is a significant patient safety issue in play with double-booked surgeries. The literature in fact, denotes the opposite. In a recent JAMA article, Sun et al performed a population-based retrospective study to ascertain post-operative outcomes of patients who underwent surgery under double-booked conditions2. The cohort included over 60,000 adult patients, and patients were analyzed for in-hospital mortality, post-operative complications, and surgical features. It was concluded that patients who were in double-booked surgeries did not experience any increase in mortality or complication rates. Yet, the average length of time in surgery was larger for double-booked surgeries, which conforms to previously stated concerns. These research results were critical for providing data to mitigate existing patient safety concerns on double-booked surgeries.
To conclude, the practice of double-booking surgeries allows for benefits, as well as costs, to individual physicians along with hospitals and healthcare institutions on a large scale. Anesthesiologists and anesthesia staff, who are intricately involved in surgery coordination, will find importance in understanding the policies, research, and practice connected with this occurrence.
1. Allen, Robert W., et al. “First Case On-Time Starts Measured by Incision On-Time and No Grace Period.” Journal of Healthcare Management, vol. 64, no. 2, 2019, pp. 111–121., doi:10.1097/jhm-d-17-00203.
2. Sun, Eric, et al. “Association of Overlapping Surgery With Perioperative Outcomes.” Jama, vol. 321, no. 8, 2019, p. 762., doi:10.1001/jama.2019.0711.