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July 2011

The True Cost of Operating Room Time—Reply

Author Affiliations

Author Affiliations: Econometric Institute, Erasmus University Rotterdam, Breda, the Netherlands.

Arch Surg. 2011;146(7):886-887. doi:10.1001/archsurg.2011.164

In reply

We very much appreciate the interest that Dr Tsai has in our work on consecutive scheduling of cases with fixed operating room (OR) teams. It is commonly agreed that the methods used to improve the reliable time estimate of surgical cases will lead to improved timeliness, efficiency, and effectiveness of OR processes. A main objective in operations management, and therefore OR management, is to identify sources of variation. Although variation does exist and will always exist in every OR process, controlling the identified variation helps managers and clinicians to improve efficiency by aligning the health service delivery processes with the desired results.1 Controlling variation of OR schedules and processes has a further, second-order effect of reducing variation and improving quality not only in the OR but also in subsequent processes throughout the hospital. In addition, OR management tries every day to maximize OR efficiency by filling the gaps in schedules with as many (planned and unplanned) cases as possible, balancing the additional costs of cases running late. From a financial point of view, the contribution margin for the hospital may benefit as more cases are performed within the available OR time. Because multiple resources in the OR are involved and because there is uncertainty about resource usage, finding optimal schedules is not a trivial concern.

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