Enterprise-wide patient scheduling information systems to coordinate surgical clinic and operating room scheduling can impair operating room efficiency.

A s revenues have decreased, health care systems have instituted intensive cost reduction programs, such as the use of pharmaceutical practice guidelines, to attempt to maintain profitability. After implementing such initiatives, some health care systems are having difficulty in further decreasing costs without sacrificing customer (patient) service. The next generation of process improvement efforts may come through deployment of information technology. For example, information systems are being developed and implemented to coordinate the scheduling of patient appointments among different sites within a health care system. The challenge in using these information systems is to decrease overall costs by scheduling patients to match optimally available providers, while simultaneously improving customer service, including patient access to appointments and ease of making those appointments. Enterprise-wide patient scheduling systems (EWPS) permit clerks, nurses, physicians, or patients (e.g., via the Internet) to schedule patient appointments throughout a multiple-specialty physician group and/or health care system. An application of these EWPS in perioperative medicine is the coordination of patient scheduling in surgeons’ clinics with patient scheduling in surgical suites. Better coordination of clinic and operating room (OR) schedules is an important objective for health care systems. This is because most costs related to delivering surgical services are for staff (1). In addition, patient satisfaction with health care systems relies in part on the ease of obtaining timely appointments (2). Depending on the structure of the health care system, the OR staff costs may include not only wages for OR nurses, but also for surgeons and anesthesiologists (e.g., at state-funded hospitals) (1). Perioperative costs can be reduced if cases are scheduled such that the workload evenly matches scheduled staffing. Specifically, to minimize the cost per case, “downtime” must be minimized. Because evenly matching workload and staffing is important, properly choosing the day on which each patient will have surgery (3) is the most important decision affecting OR labor costs. A second factor in evenly matching OR workload and staffing is how long patients have to wait for their surgeries. Patients generally want to have surgery as soon as possible (4). Thus, by better managing surgical patient scheduling, health care systems can decrease the cost per case (i.e., increase OR utilization) while maintaining or even improving patient satisfaction. The goal of this article is to review the management sciences literature to assist health care systems in programming EWPS information systems so that they can be used to increase OR efficiency. The article is divided into six sections that review: