• Franklin Dexter, Richard H Epstein, and Eric S Schwenk.
• Division of Management Consulting, Department of Anesthesia University of Iowa, Iowa City, IA, United States of America. Electronic address: Franklin-Dexter@UIowa.edu.
• J Clin Anesth. 2019 Mar 1; 53: 20-26.

Study ObjectiveSwitching from one specialty to another increases mean turnover times (i.e., interval between the exit and entrance of consecutive patients in an operating room [OR]). We estimate the effect on the mean tardiness of to-follow surgeons from following another surgeon of a different versus same specialty. Tardiness of a case's start time refers to the number of minutes the patient enters the OR later than scheduled; tardiness is 0 min if the patient enters early. Tardiness cause surgeon waiting. There are multiple causes of tardiness, but, most often, the preceding case(s) took longer than estimated.Design10-year historical cohort study with all surgical cases performed during regular workdays.SettingLarge teaching hospital.MeasurementsEstimated OR end times were calculated using a Bayesian method. Because tardiness is influenced by the estimated case start time (i.e., later starting cases have greater tardiness), tardiness values were adjusted to a 12 noon start time for the 2nd surgeon.Main ResultsThe cases of to-follow surgeons in ORs had mean tardiness of 45.1 (SE 0.6) min. When the to-follow surgeon in the OR was of a different versus the same specialty from the first surgeon, the mean turnover time was 7.3 (0.4) min longer (P < 0.00001). However, the mean tardiness was not significantly affected (0.1 min, 95% confidence interval [CI] -2.7 to 3.0 min; P = 0.93). In comparison, if one or more of the preceding cases in an OR was an add-on case, the increase in mean tardiness was 35 min (95% CI 28 to 43 min; P < 0.00001).ConclusionsOR managers can assure surgeons with afternoon starts that following a surgeon of a different specialty generally will not increase their waiting time. Case scheduling should focus on reducing over-utilized OR time and thus the hours that anesthesiologists and nurses work late.Copyright © 2018 Elsevier Inc. All rights reserved.

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