The Order of Cases

Here's a very simple operating room scheduling question. If you have several short cases and one long complex case, how do you order them? If you start with the long case, you can tackle the difficult, challenging surgery first. If additional resources are needed; for example, if the surgeon got into trouble, it's easier to deal with that during the daytime than the nighttime. But leading with the complex case means that if it is cancelled for any reason, then there's a big gap that will be hard to fill. If the case is unpredictable in timing, there could be a big delay for the subsequent patients. The opposite, to start with the predictable short cases and follow with the long case gives more predictability to the day, but it means the surgeon might be tired when he needs to be most attentive. Staff who work on shifts such as nurses, and in some cases, anesthesiologists, may change half-way through the long case if it starts in the afternoon.

In reality, there doesn't seem to be any steadfast rule about booking cases. Sometimes, surgeon preferences are honored. Sometimes, patient preferences are acknowledged. But when things get canceled, delayed, or changed, we start thinking about how to make this process a little more efficient.