Scheduling

Karolinska Hospital faced a crisis as the pressure on operating budgets was

rising. This prompted an investigation as to how well expensive resources
were being utilised. It was soon identified that operating theatres were not
being used effectively. In fact, surgeons, operating theatre staff and of
course the theatres
themselves were idle for more than 50 per cent of the time. It soon became
clear that the schedule of patients through the theatre needed to be
managed more carefully. The scarce resource was time in the theatre itself,
so the management looked at ways to reduce the time that patients spent in
the theatre. A significant step forward created a separate patient preparation
area allowing this activity to be carried out in parallel rather than in
sequence with surgery. Further investigation revealed that some delays were
caused because anaesthetists were called away to other parts of the
hospital. Adding anaesthetists formally to the operating room staff team and
creating an anaesthesia clinic to evaluate preoperative patients also
improved the efficiency of the system.
Once the throughput through the bottleneck had been increased, more
operations could be carried out in the same timeframe, and waiting times
were dramatically reduced. The unforeseen benefit was that it was now
possible to create a much more reliable schedule because the lead time
between diagnosis and surgery was dramatically reduced. Patients were
happier because they were treated faster and there were fewer noshows
than there had been when lead times were longer. A consistent theatre
schedule meant that any tests
required prior to surgery could be arranged with more certainty. Previously,
these tests had been frequently repeated as surgery dates had been
delayed.
For Karolinska, then, this approach to scheduling has paid off in a number of
ways. The theatre carries out more operations per day, costs are reduced
and patients are seen more quickly. Operating rooms were reduced from 15
to 13, while the number of operations per day was increased by 30 per cent.