Systematic approach to scheduling smoothes out the daily wrinkles.

I n many surgery departments, schedule management is a daily struggle. Staff work hard to manage case requests, juggle resources, and respond to changes, but errors , inefficiencies, and general frustration persist. The results are frequent case delays and cancellations, low utilization, high costs, low staff morale, and poor surgeon satisfaction. The key to effective scheduling is to develop solid processes for booking cases, creating a daily operational plan, and responding flexibly to emerging conditions. Well-designed scheduling systems are built on 4 principles of effective information management and workflow planning. OR efficiency starts with the accurate boarding of the surgical case. In many ORs, however, boarding processes are complex and poorly controlled. A common problem is that different staff members may handle different phases of the scheduling process, with separate responsibilities for various OR units and out-of-OR areas. This creates disconnects and information gaps. The solution is to establish a centralized scheduling office staffed by a dedicated nurse coordinator. This coordinator will receive all schedule requests, book cases, assist in managing the daily schedule, and provide clinical oversight of the entire scheduling process. Another problem in many ORs is that surgeons are allowed to make schedule requests via multiple avenues, including phone calls, emails, faxes, and in-person requests. This leads to inconsistent information capture—some surgeons provide only minimal details about the patient and the procedure. The solution is to establish a single vehicle for scheduling surgical cases. Many leading ORs have developed a standardized fax form for submitting schedule requests. Typically, the form is developed with multidisciplinary input so that it reflects the information needed by surgeons, anesthesiologists, OR nursing, materials management, and other stakeholders. Required fields should include full patient demographics and complete procedure information (specifying admission type and anesthesia needs). The form should also include space to specify any special instructions or equipment needs (sidebar, p 22). We recommend adopting an electronic solution for managing fax requests. Several vendors offer electronic fax management systems capable of receiving scheduling requests, assembling information into organized folders, and facilitating active management of case information. Well-organized ORs also integrate scheduling with other perioperative processes and functional areas. Booked cases are automatically pushed to preadmission testing (PAT) so staff can immediately initiate patient triage and preoperative testing protocols. Similar links can be created to drive proactive interventions in case management , admissions, and patient financial services.