Abstract
At surgical suites with long workdays, anesthesia clinicians typically receive lunch breaks. We estimated the percentage relative impact of decision-making processes on 30-min breaks completed during cases' surgical periods and during two-hour windows (e.g., 11:00 AM to 1:00 PM).
Discrete-event simulations of breaks were performed using a retrospective cohort of a large teaching hospital's 15 years of actual dates (N = 5481 days), operating rooms (N = 53) in three surgical suites, surgical times (N = 460,354), and scheduled procedures (N = 30,212).
Giving breaks preferentially to rooms with cases that had the least predicted time left until the end of surgery, provided the end of surgery was expected to be late enough to finish after the break, resulted in 16.5% fewer breaks versus giving preference to longest ongoing cases (P < 0.0001). Pooled lists (i.e., using a single queue) with preferences for the longest ongoing cases resulted in overall 7.2% more complete breaks, with these substantive increases achieved for all three suites (all four P < 0.0001). Using a pooled list and giving preference to the longest ongoing cases first achieved 28.4% more complete breaks than assigning each clinician to serve sequential near-adjacent rooms, and having those clinicians prioritize the cases with the least predicted time until the end of surgery (95% confidence interval 27.7–29.1%). Sensitivity analyses showed that results were insensitive to the specific time windows for breaks. Sensitivity analyses also showed the mechanism. If every case in every room daily was the same surgical procedure, then the strategy of prioritizing cases with the least predicted time left would be comparable to prioritizing cases that have been ongoing the longest. However, in the presence of high coefficients of variability in surgical times, following log-normal distributions, prioritizing cases with the least predicted time left resulted in more incomplete breaks.
For each clinician in a suite giving breaks, assign them to a first room to break. Then, while the first set of breaks is being completed, choose the next set of rooms for breaks with preference to cases having been ongoing the longest.
•Clinical directors working at surgical suites with long workdays assign lunch breaks•Breaks were simulated by using 15 years of actual dates, rooms, and surgical times•Prioritizing breaks to cases with the least predicted time left resulted in fewer breaks•Prioritizing breaks to cases that had been ongoing the longest resulted in more breaks•Single, pooled queues resulted in more successfully completed breaks.•Results were insensitive to the specific times for the breaks (e.g., 11–1)