Use of Predictive Modeling to Improve Operating Room Scheduling Efficiency

使用预测建模提高手术室调度效率

• 批准号: 8594571
• 负责人: David H. Berger
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-11-01 至 2016-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8594571
• 关键词: Address; Anesthetics; Area; Biological Models; Budgets; Caring; Cessation of life; Characteristics; Client satisfaction; Complex; Computer Simulation; Data; Development; Equipment and supply inventories; Fees; Goals; Growth; Health Services Accessibility; Hemorrhage; Hospitals; Human Resources; Individual; Intervention; Length; Life; Methodology; Methods; Mission; Modeling; Monitor; Myocardial Infarction; Operating Rooms; Operative Surgical Procedures; Outcome; Patients; Perioperative; Productivity; Provider; Randomized; Regression Analysis; Repeat Surgery; Reporting; Resources; Running; Sampling; Schedule; Services; Simulate; Stroke; Structure; Surgeon; Surgical Specialties; System; Time; Uncertainty; Vascular Surgical Procedures; Wound Infection; arm; base; burnout; clinically relevant; cost; design; frontier; improved; operation; patient population; predictive modeling; pressure; satisfaction; surgical service

DESCRIPTION (provided by applicant): Background: Operative suites (OS) are highly specialized areas of a hospital where complex surgical procedures are performed. OS utilization has a direct impact on the hospital budget as it influences the allocation of a large array of resources. Within the VHA system the annual OS related expenses have been increasing by 5.4% annually for the last six years. Official data indicate the presence of substantial variability in OS utilization throughout the VHA and indicate that maximizing OS efficiency is of paramount importance for the VHA mission. Streamlined workflow and successful prediction of time length for individual operations are the two key determinants of OS efficiency. Operative time length has been traditionally calculated as the mean historic operative time for a particular intervention. However, this value accurately predicts the surgical length in only a small fraction of cases. To address this issue we used patient, surgeon, and OR characteristics and developed a regression model based methodology that can predict the operative and anesthetic case length for all major types of vascular surgical procedures. We validated this method in out of sample patient populations and showed that it can greatly improve the precision of predicting surgical case duration. Use of such a predictive modeling to assess improvement in OS efficiency has not been previously reported. Objectives: The goal of the proposed study is to address the efficacy of a scheduling methodology that uses a regression-based predictive modeling system (PMS) to calculate operative and anesthetic time length. We hypothesize that compared to the traditional scheduling system (TSS) that calculate operative length using historic means, case allocation in an operating room using the PMS will improve scheduling precision, increase operative volume and increase OS personnel satisfaction, without having adverse impact on patient outcomes. Methods: We will use a randomized block design according to which blocks of weekly schedules will be randomly structured using either the TSS or the PMS methods for a total of 100 operative days. Specific Aim 1. Evaluate the impact of the PMS vs. TSS on operating room utilization. Hypothesis 1.1. PMS results in greater scheduling precision compared to TSS. The primary endpoint will be the overall time (in minutes) of scheduling imprecision, defined as the room over- or under-utilization; the anticipated end of the operative day will be determined each morning using either the TSS or the PMS methods; the length of time in minutes of over- or under-utilization will be calculated at the end of the day to determine the daily scheduling imprecision. Hypothesis 1.2. PMS is associated with increased operating room productivity. We anticipate that the improved scheduling precision will result in increased operative volume when the operative schedule is constructed based on the PMS. A clinically relevant increase by at least 10% in throughput using the PMS is hypothesized. Specific Aim 2. Assess the impact of the PMS on OS personnel satisfaction Hypothesis 2.1. The PMS is associated with superior OS personnel satisfaction. We anticipate that improved scheduling precision that reduces uncertainty during the day and decrease the need for overtime will increase OS staff satisfaction, as this is captured with the Maslach Burnout Inventory that will be given to providers during the last day of the operative week. Specific Aim 3. Assess the impact of PMS utilization on important perioperative outcomes Hypothesis 3.1. The PMS will not result in increased rate of a composite endpoint of perioperative death, myocardial infarction, stroke, bleeding, early reoperation, and wound infection. Complications will be documented prospectively to assure that introduction of PMS does not place pressures on surgeons to maintain consistent operative time at the expense of quality of provided care.

描述（由申请人提供）： 背景：手术室（OS）是医院中进行复杂外科手术的高度专业化区域。操作系统利用率对医院预算有直接影响，因为它影响大量资源的分配。在VHA系统中，过去六年来，每年与OS相关的费用每年增长5.4%。官方数据表明，在整个VHA中，操作系统利用率存在很大的差异，并表明最大限度地提高操作系统效率对VHA使命至关重要。简化的工作流程和成功预测单个操作的时间长度是OS效率的两个关键决定因素。手术时间长度传统上被计算为特定干预的平均历史手术时间。然而，该值准确预测了 手术长度仅在一小部分病例中。为了解决这个问题，我们使用患者、外科医生和手术室特征，并开发了一种基于回归模型的方法，可以预测所有主要类型血管外科手术的手术和麻醉病例长度。我们在样本患者人群中验证了该方法，并表明它可以大大提高预测手术时间的精度。使用这种预测建模来评估OS效率的改善以前尚未报道。目的：拟议研究的目标是解决使用基于回归的预测建模系统（PMS）来计算手术和麻醉时间长度的调度方法的有效性。我们假设，与使用历史平均值计算手术时间的传统调度系统（TSS）相比，使用PMS在手术室中进行病例分配将提高调度精度、增加手术量并提高OS人员满意度，而不会对患者结局产生不良影响。研究方法：我们将使用随机区组设计，根据该设计，每周计划的区组将使用TSS或PMS方法随机构建，共100个手术日。具体目标1.评价PMS与TSS对手术室利用率的影响。假设1.1.与TSS相比，PMS的调度精度更高。主要终点将是计划不精确的总时间（分钟），定义为房间过度使用或使用不足;每天早晨将使用TSS或PMS方法确定手术日的预期结束时间;将在一天结束时计算过度使用或使用不足的时间长度（分钟），以确定每日计划不精确。假设1.2. PMS与手术室生产力的提高有关。我们预计，提高调度精度将导致增加手术量时，手术时间表构建的基础上PMS。假设使用PMS的吞吐量至少增加10%，具有临床相关性。具体目标2。评估PMS对OS人员满意度的影响假设2.1。PMS与上级OS人员满意度相关。我们预计，提高调度精度，减少白天的不确定性，减少加班的需要，将提高操作系统员工的满意度，因为这是在手术周的最后一天提供给供应商的Maslach倦怠清单中捕获的。具体目标3。评估PMS使用对重要围手术期结局的影响假设3.1。PMS不会导致围手术期死亡、心肌梗死、卒中、出血、早期再手术和伤口感染复合终点的发生率增加。将前瞻性地记录并发症，以确保PMS的引入不会给外科医生带来压力，要求他们以牺牲所提供的护理质量为代价来维持一致的手术时间。