Surgical Block Time Satisfaction: One Institution's Experience Across 12 Surgical Disciplines, With A Focus On Plastic Surgery
Pooja S. Yesantharao, MS, Erica Lee, MS, Franca Kraenzlin, MD, Sarah Persing, MD, MPH, Karan Chopra, MD, Helen Xun, BS, Justin M. Sacks, MD, MBA.
Johns Hopkins Medicine, Baltimore, MD, USA.
Purpose: Block scheduling optimizes operating room resources. While most studies investigate block scheduling from a hospital's perspective, surgeons' perspectives have not been characterized. This is especially important to study for Plastic & Reconstructive Surgeons, whose cases contribute substantially to hospitals' additional marginal revenues in tertiary care centers with dedicated reconstructive services. We assessed surgeon satisfaction with block scheduling at an academic/tertiary-care hospital.
Methods: This was an IRB-exempt cross-sectional investigation of attending surgeons across 12 departments. Surgeons were queried by e-mail for demographics and opinions on surgical block allocation/satisfaction/efficiency. Chi square and Student's t test analyses were used for comparative analyses, and univariate followed by stepwise inclusion into a multivariate logistic regression was used to study block time satisfaction. Sub-group analyses stratified by gender and level of training (i.e. fellowship versus not fellowship-trained) were also completed to comparatively study differences in satisfaction with block time allocation among these surgeon cohorts.
Results: Of 77 surgeons surveyed, 11% were Plastic Surgeons. Overall, only 10% of surgeons were completely satisfied with their allocated blocks, none of whom were Plastic Surgeons. Amongst all surgeons, gender did not significantly impact block allocation/satisfaction, but level of training did. Eighty-six percent of surgeons overall were fellowship-trained, while 100% of Plastic Surgeons were fellowship-trained. Fellowship-trained surgeons were significantly more likely to have their preferred block times than non-fellowship-trained surgeons (59.1% versus 27.2%, p=0.04). However, while fellowship training was significantly associated with increased block-time satisfaction in the overall surgeon cohort (p=0.03), Plastic Surgeons had significantly lower odds of satisfaction even after adjusting for fellowship training (OR: 0.3, p=0.02). Among all surgeons, most believed that their allocated blocks negatively impacted their career goals (67%) and patient care (70%) regularly. Furthermore, only around one third of survey respondents (36%) agreed or strongly agreed that block time allocation is fair, while 30% were neutral and 34% disagreed or strongly disagreed that block time allocation is fair (Figure). Finally, surgeons were asked to propose changes to improve block time allocation, and the top themes identified included "adjusting case time lengths on the OR schedule with surgeon input" (27.5%), "increased flexibility in block time release/reassignment" (25%), and "increased transparency in block time allocation" (22.5%).
Conclusions: This is the first study to consider surgeons' perspectives on surgical block scheduling, revealing potential gaps in the current process at a tertiary academic medical center. Plastic Surgeons had lower block-time satisfaction despite fellowship training, possibly because these surgeons routinely perform cases for which they are not the primary surgeon (i.e. joint cases or salvaging complications from other surgeries) or they have a perceived lack of control in the process. Greater transparency and incorporation of surgeon input into block-time allocation may improve global satisfaction and enhance surgeons' professional development/patient care, by involving more stakeholders in the peri-operative environment.
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