Double-Booked Surgeries: Policy and Practice for Anesthesiologists

By April 22, 2019Uncategorized

Operations Management for hospitals, healthcare providers, and outpatient units that provide surgical services encounter several challenges with respect to managing census and providing services in a timely, cost-effective operation. One central challenge that has gained traction in the press is that on the instances of double-booked surgeries. As the name suggests, double-booked surgeries refers to the practice in which a lead surgeon, and potentially a lead anesthesiologist, is assigned to more than one surgery scheduled in the same time-slot. In this manner, the lead physician will typically execute the major or most complex parts of the surgery, leaving the simpler elements to physicians-in-training, e.g. residents and/or fellows. In many ways, the process of double-booking surgeries is treated as an educational training tool. Junior physicians are able to observe experts in the field, while also taking on significant surgical tasks that will mirror their clinical responsibilities as full-time, attending physicians. However, there are also potential downsides to the practice as detailed in the literature, namely that double-booked surgeries may pose a risk to the patient, and can be logistically difficult to execute from the management perspective. This article will detail the challenges associated with double-booking surgeries for anesthesiologists and practice managers, while also considering the impact to patient population.

The practice of double-booking surgeries, while mainstream at many healthcare institutions, can pose a serious administrative challenge to practice managers. Double-booking surgeries requires a level of coordination at the individual level. Surgeons must identify which segments of the surgery are most difficult to perform, and effectively communicate these recommendations to operating room (OR) managers, who then schedule surgeries in specific OR rooms and with associated staff, including anesthesiologists. For lead anesthesiologists and other anesthesia staff, the process of a surgeon moving from room to room can be a distraction. Specifically, one viable side effect of double-booking surgeries is the potential for tardiness. Tardiness can contribute to OR delays, result in anesthesiologists and anesthesia staff working over-time, and cause an unnecessary cost burden to the institution. Allen et al measured the impact of tardiness on surgical healthcare institutions in the Journal of Healthcare Management1. The research team concluded that each lost minute in the OR was valued at approximately $9.56 in associated costs. In an intervention that targeted delayed surgical start times, part of which were attributed to the presence of double-booked surgeries, cost savings resulted in over $700,000 to the facility. Therefore, if not executed smoothly, double-booked surgeries may represent a significant economic impact to the hospital.

In addition to the economic impact of double-booked surgeries, patient safety represents a viable cause for concern. Given that double booking surgeries requires multiple transitions during the operation, combined with junior surgeons performing a majority of the surgery, several thought leadership pieces have questioned whether there is a significant patient safety issue associated with double-booked surgeries. The literature in fact, suggests the opposite. In a recent publication in JAMA, Sun et al conducted a large-scale retrospective study to determine post-operative outcomes of patients who underwent surgery under double-booked conditions2. The cohort included over 60,000 adult patients, and data points were analyzed for in-hospital mortality, post-operative complications, and surgical characteristics. It was found that patients who were in the
double-booked situation did not experience any increase in mortality or complication rates.

However, the mean length of time in surgery was increased for double-booked surgeries, which aligns with previously stated concerns. This research was impactful for providing data to counter any patient safety concerns around double-booked surgeries, while acknowledging that the surgery itself may be impacted in ways including time.

surgical characteristics. It was found that patients who were in the double-booked situation did not experience any increase in mortality or complication rates.

However, the mean length of time in surgery was increased for double-booked surgeries, which aligns with previously stated concerns. This research was impactful for providing data to counter any patient safety concerns around double-booked surgeries, while acknowledging that the surgery itself may be impacted in ways including time.

To sum, the process of double-booking surgeries provides benefits, as well as costs, for individual physicians as well as healthcare institutions at-large. Anesthesiologists and anesthesia staff, who are deeply involved in surgical coordination initiatives, will find value in understanding the policies, research, and practice connected with this initiative.

1. Allen, Robert W., et al. “First Case On-Time Starts Measured by Incision On-Time and No Grace Period.” Journal of Healthcare Management, vol. 64, no. 2, 2019, pp. 111–121., doi: 10.