Use of Predictive Modeling to Improve Operating Room Scheduling Efficiency

This study compares two different methodologies of scheduling cases in the operating room.

Study Overview

• Status: Completed
• Conditions: Operating Room Scheduling
• Intervention / Treatment: Other: Scheduling using historical means; Other: Scheduling using regression modeling system

Detailed Description

The goal of the proposed study is to address the efficacy of a scheduling methodology that uses a regression-based predictive modeling system (PMS) to calculate operative and anesthetic time length. The investigators hypothesize that compared to the traditional scheduling system (TSS) that calculate operative length using historic means, case allocation in an operating room using the PMS will improve scheduling precision, increase operative volume and increase Operative Suite (OS) personnel satisfaction, without having adverse impact on patient outcomes. The investigators will evaluate this hypothesis using a randomized block design in two operating rooms of a single surgical specialty for a total of 100 operative days per arm.

• Study Type: Interventional
• Enrollment (Actual): 735
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • Michael E. DeBakey VA Medical Center, Houston, TX

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• The only requirement for including a day in the study will be that all the procedures performed in that specific day have been previously performed in our hospital at least 5 times a year for each of the last three years. This rule will encompass the vast majority of the performed vascular procedures in our facility. Setting the threshold at a minimum of 5 cases per year is essential to assure that some data will be available to calculate the expected length of the case with either the traditional or the predictive modeling system. If a case is performed in a day when the scheduling imprecision is supposed to be calculated using the PMS but modeling data do not exist, then the anticipated length of this case will be calculated using the historic means.
• Surgery cancellation after the first case will not disqualify that day from inclusion in the study. If the cancellation occurs in the last case of the sequence for the specific day then no particular intervention will be taken. The anticipated end of the surgical day will reset to the end of the last case that took place, and all the imprecision calculations will be performed as described below. If the cancellation occurs in one of the intermediate cases, then the end of the operative day will reset to reflect the removal of the cancelled case.

Exclusion Criteria:

A day will be excluded from the study when any of the following occur (based on historical data the investigators anticipate 10-15% of the operative days to meet the exclusion criteria):

• Only one or no cases have been scheduled for the entire operative day
• An emergency case is added as first case, or in between the scheduled cases.
• The operative day falls during a major holiday week (Thanksgiving, Christmas, New Year). The schedule during these time periods tends to be fragmented, cancellation rates are high, and cases are frequently performed with back-up teams only. All these factors may distort the findings.
• There is an unusual case in the schedule that does not meet the minimum requirement of 5 previous operations on a yearly basis for the last three years.
• The first case of the day is cancelled

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: QUADRUPLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Historical means method; Operative time will be predicted using historical service means. Schedule will be constructed using this time	Other: Scheduling using historical means; Scheduling will be performed taking into account historical means only for anesthetic, operative, and turn around time
EXPERIMENTAL: Predictive Modeling System (PMS); Operative time will be predicted using a regression model. Schedule will be constructed using this time	Other: Scheduling using regression modeling system; A regression model that uses predictor of operative length will be used to predict operative, anesthetic, and turn around time length

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference Between the Actual and Predicted Length of Operative Day (in Minutes)	The scheduling imprecision between the two scheduling approaches will be compared. Scheduling imprecision is defined as the difference between the actual and predicted length of operative day.	Three years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference in Throughput	Difference in total number of cases scheduled per unit of time analyzed between the two study arms	Three years
Operative Suite Personnel Job Satisfaction	Comparison of job satisfaction between study arms using three domains of the Maslach Burnout Inventory: Depersonalization (range 0-17, score of 17 indicates worse depersonalization). Emotional Exhaustion (range: 0-36, score of 36 is the worse). Personal accomplishment (range 1-60, score of 60 is best).	Three years
Complications: A Composite Endpoint of Death, Myocardial Infarction, Bleeding, Amputation	Comparison of the perioperative (30-day postoperative) composite endpoint of death, myocardial infarction, bleeding, amputation between the two study groups	Three years

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Panagiotis Kougias, MD MSc, Michael E. DeBakey VA Medical Center, Houston, TX; Principal Investigator: David H. Berger, MD, Michael E. DeBakey VA Medical Center, Houston, TX

Publications and helpful links

General Publications

• Kougias P, Tiwari V, Sharath SE, Garcia A, Pathak A, Chen M, Ramsey D, Barshes NR, Berger DH. A Statistical Model-driven Surgical Case Scheduling System Improves Multiple Measures of Operative Suite Efficiency: Findings From a Single-center, Randomized Controlled Trial. Ann Surg. 2019 Dec;270(6):1000-1004. doi: 10.1097/SLA.0000000000002763.

Study record dates

Study Major Dates

• Study Start: August 1, 2013
• Primary Completion (ACTUAL): December 1, 2015
• Study Completion (ACTUAL): July 1, 2016

Study Registration Dates

• First Submitted: July 1, 2013
• First Submitted That Met QC Criteria: July 1, 2013
• First Posted (ESTIMATE): July 8, 2013

Study Record Updates

• Last Update Posted (ACTUAL): January 2, 2018
• Last Update Submitted That Met QC Criteria: May 24, 2017
• Last Verified: May 1, 2017

More Information

Terms related to this study

• Keywords: Operating room utilization
• Other Study ID Numbers: IIR 12-113

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO