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Vascular Surgery Weekends: Or Time Allocation And Delays Leading To Worse Patient Outcomes And Staff Fatigue
Adel Hanandeh, MD, Garietta Falls, M.D, FACS, James Persky, M.D, FACS.
Department of Vascular & Endovascular Surgery Case Western Reserve University / MetroHealth System, Cleveland, OH, USA.
OBJECTIVE: This study investigates the effects of weekend operating room time allocation and delays on patient outcomes and staff fatigue within the vascular surgery department. With increasing demand for timely vascular interventions, this project seeks to identify inefficiencies in weekend OR scheduling and their impact on patient care and provider well-being.
METHODS: A retrospective analysis of vascular surgery cases performed on weekends from May 2022 to April 2023. We reviewed patient records to assess the frequency and causes of delays, defined as cases starting more than 10 minutes later than scheduled. Additionally, a survey was distributed to vascular surgery providers to evaluate their levels of fatigue and perceptions of how delays affect patient outcomes. The survey targeted general surgery residents and vascular surgery attendings.
RESULTS: Among 917 weekend surgeries, 88 were vascular cases. Of these, 63% experienced delays, with an average delay time of 62 minutes and the longest delay reaching 394 minutes. Delays were predominantly due to the Snowball Effect, where previous cases’ overruns caused subsequent delays (84%). The distribution of delays varied by month, with significant delays noted in October, April, and July. The provider survey revealed that 100% of respondents reported fatigue attributable to these delays and believed that delays negatively impacted patient outcomes, such as worsening symptoms and increased risk of complications.
CONCLUSIONS: Delays in weekend vascular surgeries result in extended waiting times for patients, which can aggravate conditions like peripheral artery disease and lead to higher healthcare costs. Such delays also contribute to significant provider fatigue, affecting performance and decision-making. Implementing Lean management principles to streamline OR scheduling, optimizing preoperative preparation, and increasing weekend OR availability are crucial steps to improve efficiency. Addressing these issues can enhance patient care, reduce delays, and alleviate provider fatigue, ultimately leading to better overall outcomes and more effective use of resources.
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