MMHA 6700 Week 5 OR Block Schedule Review Example

Blocks That Fill on Thursday and Beds That Run Out on Wednesday: A Review of the Operating Room Block Schedule

Student Name

Walden University

MMHA 6700: Healthcare Operations

Instructor Name

Month Day, Year

Blocks That Fill on Thursday and Beds That Run Out on Wednesday: A Review of the Operating Room Block Schedule

Purpose

Linden Ford Medical Center, the hypothetical community hospital this term's assignments share, runs eight operating rooms on weekdays under a block schedule. Each surgical service owns blocks of time on particular days and may book cases into them; unused time is released to other services at a set point before the day of surgery. The Week 1 profile found that scheduled surgical admissions cluster from Tuesday to Thursday, the same days inpatient occupancy peaks and emergency boarding is worst. This review asks two questions: how well are blocks used, and does the shape of the schedule contribute to midweek bed shortages?

How Block Use Is Measured

Block utilization is commonly calculated as the hours of surgery performed within a service's block, plus turnover time between cases, divided by the hours allocated. A block that is booked but runs short, or released too late to fill, counts as unused. Utilization alone is a weak guide to whether a service should gain or lose time, because high utilization can reflect overbooked days with long overruns, and adjusting blocks on utilization tends to chase random variation (Wachtel & Dexter, 2008). The review therefore reports utilization alongside release timing and the day-of-week pattern of inpatient admissions each service generates.

Block Use by Service

Gynecology and vascular surgery use less than two-thirds of their blocks, and both release time a day before surgery. Late release is the main reason their unused time goes to waste: other services cannot book cases, arrange equipment and prepare patients in a single day. Research on block scheduling suggests that releasing unused block time earlier allows it to be filled by services with waiting cases, and that surgeons and patients will accept modest scheduling changes when the hospital explains them (Dexter et al., 1999).

Table 1

Block Allocation and Use, Last Quarter (Illustrative)

Two services release unused time only 24 hours ahead, too late for others to book. Orthopedics, the largest source of scheduled admissions, concentrates them midweek.

The Link to Midweek Bed Shortages

Orthopedic joint replacements and general surgery cases generate inpatient stays of two to four days. When they cluster on Tuesday and Wednesday, their patients occupy beds through Thursday and Friday. Together with the steady flow of emergency admissions, those surgical stays lift occupancy to about 94 percent in the middle of the week, as the Week 1 profile found. On Sundays, with almost no scheduled admissions, occupancy falls to about 82 percent.

This pattern is well described. A study of a children's hospital found that variability in scheduled surgical caseload, rather than emergency demand, was the main driver of intensive care unit crowding and diversion (McManus et al., 2003). The broader argument for smoothing elective admissions is that hospitals create much of their own peak demand through scheduling, and can reduce it without adding beds (Litvak & Fineberg, 2013).

Table 2

Scheduled Surgical Admissions by Day and Midweek Occupancy (Illustrative)

Scheduled admissions peak a day ahead of occupancy, which is what an average stay of two to four days would predict.

Recommendations

The review makes four recommendations. First, move the release deadline for all blocks to 72 hours before surgery, with a weekly report to the perioperative committee showing released hours and how many were filled. Second, reduce gynecology and vascular blocks modestly, moving the time to open booking rather than to another service, so that any service can use it. Third, work with orthopedics to shift a portion of joint replacement blocks from Tuesday and Wednesday to Monday and Friday, so that their two- to three-day stays end before the weekend rather than midweek. Fourth, track scheduled inpatient admissions by day of week as a standing measure, beside block utilization.

The third recommendation is the most important and the most difficult. Joint replacement patients follow a predictable course, and their discharges can be planned from the day of surgery, which makes them the best candidates for moving. A Monday case discharged on Wednesday frees a bed before the Thursday peak; a Wednesday case discharged on Friday occupies one through it. Surgeons value predictable days, and Friday operating means weekend coverage for postoperative patients. The review recommends a pilot in which one orthopedic surgeon's Wednesday block moves to Monday for three months, with weekend physical therapy staffed to support Friday cases later.

Limits

One quarter of data may not reflect seasonal patterns. The review does not consider outpatient surgery, which uses the same rooms but no inpatient beds. Utilization figures depend on how turnover time is counted, which varies between hospitals. Smoothing surgical demand will not remove emergency peaks, which follow their own pattern. Finally, the review assumes services would accept changes in their blocks; in practice, any reallocation will need negotiation with surgeons and the perioperative committee, and the pilot is designed to build evidence for that conversation rather than impose a change. A schedule that surgeons do not trust will be worked around, and booked time will drift back to the old days.

Conclusion

Linden Ford's block schedule has two problems. Some blocks are underused because they are released too late to fill. And the schedule's shape concentrates inpatient surgical admissions midweek, which drives the midweek bed squeeze that leaves admitted patients waiting downstairs. Earlier release recovers lost operating room time. Moving a portion of joint replacement blocks to the edges of the week spreads their demand for beds. Both changes target timing rather than totals, which is the theme this term keeps returning to.

References

Dexter, F., Macario, A., Traub, R. D., Hopwood, M., & Lubarsky, D. A. (1999). An operating room scheduling strategy to maximize the use of operating room block time: Computer simulation of patient scheduling and survey of patients' preferences for surgical waiting time. Anesthesia and Analgesia, 89(1), 7-20. https://doi.org/10.1213/00000539-199907000-00003

Litvak, E., & Fineberg, H. V. (2013). Smoothing the way to high quality, safety, and economy. New England Journal of Medicine, 369(17), 1581-1583. https://doi.org/10.1056/NEJMp1307699

McManus, M. L., Long, M. C., Cooper, A., Mandell, J., Berwick, D. M., Pagano, M., & Litvak, E. (2003). Variability in surgical caseload and access to intensive care services. Anesthesiology, 98(6), 1491-1496. https://doi.org/10.1097/00000542-200306000-00029

Wachtel, R. E., & Dexter, F. (2008). Tactical increases in operating room block time for capacity planning should not be based on utilization. Anesthesia and Analgesia, 106(1), 215-226. https://doi.org/10.1213/01.ane.0000289641.92927.b9