PURPOSE OF COURSE is to teach participants how to apply
principles of operations research to solve problems in the
operating room and perioperative environment:
• Monitoring operational and financial performance of surgical
suites and anesthesia groups (“descriptive analytics”),
• Forecasting case durations, time remaining in cases, use of
staffed OR time (“predictive analytics”),
• Applying principles of operations research to make common
decisions, such as staffing levels, block time planning, case
scheduling and assignment, financial management, and
strategic planning (“prescriptive analytics”),
• Identifying in-house expertise to aid in problem-solving and
determining whether outside consultants are needed,
• Evaluating current decision-support systems.
See: Wachtel RE, Dexter F. Curriculum providing cognitive knowledge
and problem-solving skills for anesthesia systems-based practice.
ACGME Journal of Graduate Medical Education 2: 624-632, 2010
See: Wachtel RE, Dexter F. Difficulties and challenges associated with
literature searches in operating room management, complete with
recommendations. Anesthesia & Analgesia 117: 1460‑1479, 2013
See: Dexter F, Van Swol LM. Influence of data and formulas on trust
in information from journal articles in an operating room management
course. Anesthesia & Analgesia Case Reports 6: 329-334, 2016
See: Ahn PH, Dexter F, Fahy BG, Van Swol LM. Demonstrability of
analytics solutions and shared knowledge of statistics and operating room
management improves expected performance of small teams in correctly
solving problems and making good decisions. Perioperative Care and
Operating Room Management 19: 100090, 2020
INTENDED AUDIENCE includes anesthesiologists, CRNAs,
nurse managers, surgeons, hospital engineers and other analysts
responsible for the organization and delivery of surgical care.
Participants should have knowledge of middle/high school level
algebra, Excel functions, and basic statistics (e.g., Student’s t-test).
The course is designed to be especially relevant to engineers and
analysts from other fields preparing to work in anesthesia/ ORs.
CASE STUDIES completed in class are an integral part of the
course. Participants include both clinicians and analysts. Many
of the case questions include electronic literature searching using
publicly available materials. The cases help participants learn which
techniques should be applied to different types of problems, how
best to present results to hospital stakeholders, and leadership
principles for team-based OR management decision making.
COURSE SCHEDULE (www.FranklinDexter.net/education.htm )
DAY 1
8:00 AM Use of economically rational ordered priorities
to make patient flow decisions
Lecture is based on the following reference article:
Dexter F, Epstein RH, Traub RD, Xiao Y.
Making management decisions on the day of surgery
based on OR efficiency and patient waiting times.
Anesthesiology 101: 1444-1453, 2004
11:00 AM Cases 1 and 2
1:00 PM Incorporating uncertainty into decision-making
3:00 PM Cases 3 and 4
5:30 PM Discussion of cases
DAY 2
8:00 AM Allocating OR time operationally
(few months before day of patient care)
Lecture is based on the following reference article:
McIntosh C, Dexter F, Epstein RH. The impact of
service-specific staffing case scheduling, turnovers, and
first-case starts on anesthesia group and operating room
productivity: tutorial using data from an Australian hospital.
Anesthesia & Analgesia 103: 1499-1516, 2006
10:00 AM Allocating OR time tactically based on utilization
(1 yr before day of patient care)
Lecture is based on the following reference article:
Wachtel RE, Dexter F. Tactical increases in OR block time
for capacity planning should not be based on utilization.
Anesthesia & Analgesia 106: 215-226, 2008
10:45 AM Cases 5 and 6
1:00 PM Allocating OR time tactically based on financial
and strategic criteria
Lecture is based on the following reference article:
Dexter F, Ledolter J, Wachtel RE. Tactical decision making for
selective expansion of operating room resources incorporating
financial criteria & uncertainty in sub-specialties’ future workloads.
Anesthesia & Analgesia 100: 1425-1432, 2005
2:30 PM Cases 7 to 9
5:30 PM Discussion of cases
OPERATIONS RESEARCH FOR SURGICAL SERVICES
DAY 3
8:00 AM Economics of small reductions in OR times
and turnover times
10:00 AM Financial impact of differences among hospitals
Lecture is based on the following reference article:
Wachtel RE, Dexter F, Lubarsky DA.
Financial implications of a hospital’s specialization
in rare physiologically complex surgical procedures.
Anesthesiology 103: 161-167, 2005
10:45 AM Cases 10 and 11
1:00 PM Empirical methods for staffing and assignments
Lecture is based on the following reference article:
Dexter F, Epstein RH. Optimizing second shift
OR staffing. AORN Journal 77:825-830, 2003
2:00 PM Physician agreements: Anesthesia institutional
support and surgeon block time
Lecture is based on the following reference article:
Dexter F, Epstein RH. Associated roles of perioperative
medical directors and anesthesia: hospital agreements
for operating room management. Anesthesia &
Analgesia 121: 1469-1478, 2015
3:00 PM Cases 12 to 15
DAY 4
8:00 AM Discussion of cases from preceding day
9:45 AM Differentiating among hospitals and
surgical practices
Lecture is based on the following reference article:
Dexter F, Ledolter J, Hindman BJ. Quantifying the
diversity and similarity of surgical procedures among
hospitals and anesthesia providers.
Anesthesia & Analgesia 122: 251-263, 2016
10:45 AM Cases 16 and 17
11:55 AM End of course
Open discussion during lunch
The University of Iowa Carver College of Medicine designates
this live activity for a maximum of 35 AMA PRA Category 1
Credits™. Physicians should claim only the credit commensurate
with the extent of their participation in the activity. Course
completion is required for CME credit.
