Thoughtful Approach to Reducing OR Time for Elective Surgeries Helps Address Significant Pandemic-Induced Staffing Shortages Safely

Decreasing operating room (OR) availability by 15% helped a hospital address a 30% staff shortage caused by the COVID-19 pandemic, according to a study being presented at the American Society of Anesthesiologists’ ADVANCE 2022, the Anesthesiology Business Event.

“The Great Resignation has disproportionately impacted health care to near-crisis levels and we were able to address ongoing staff shortages by methodically decreasing available surgical times,” said Kimberly Cantees, M.D., M.B.A., clinical director of anesthesiology and perioperative services, UPMC Presbyterian Hospital, Pittsburgh. “By using a phased approach, including daily meetings to address scheduling issues, we were able to prioritize essential surgeries and care for patients with the greatest need.”

UPMC is a comprehensive quaternary care regional and national referral center for many surgical specialties including trauma, transplantation, neurosurgery, cardiac surgery and surgical oncology. In the study, the hospital implemented a five-phased approach, which started in May 2021, to ensure that it could continue to provide essential surgical care when its surgical technologist and OR nurse vacancy rate reached 30%. The phases included:

  • Phase I (May 2021): Restricted OR availability for surgeries that were less time- sensitive and moved some to other hospitals and surgery centers in the UPMC system; decreased OR availability for surgeons with highly elective cases (e.g., sports orthopedic procedures, select hand surgery cases, some plastic surgery) and moved a small amount of surgical work to the bedside in the intensive care unit.
  • Phase II (July 2021): Formed a multidisciplinary surgical services capacity committee that met daily to ensure the staffing matched the surgical schedule for the subsequent two weeks. Values for surgical care were identified and cases such as transplant and cancer surgeries were prioritized.
  • Phase III (Oct. 2021): Reduced OR time availability by 15% when surgeries could be scheduled and extended the deadline for standard scheduling guidelines from three days to five days before surgery.
  • Phase IV (Nov. 2021): Instituted additional reduction of OR scheduling to meet continued staff shortages and reduced available OR time for all surgical services by an additional 10%. Surgeons with two ORs had their time reduced for all services, except for the care of trauma patients.
  • Phase V (Jan. 2022): Implemented UPMC system-wide review of surgical case prioritization and opened more ORs for booking, which allowed greater flexibility for performing surgeries depending on staffing availability.

Over the course of the phased approach, the available ORs were decreased from 36 to 31 (15%). This has been adequate to address the 30% reduction in surgical services staff, said Dr. Cantees. The hospital has continued to use the approach to successfully address staffing challenges during the Omicron surge.

Dr. Cantees said the phased approach received minimal pushback from surgeons, mostly because of clear communication of both the staffing hurdles, as well as established surgical priorities. Communication occurs via regular meetings, e-mail and personal communication between members of the multidisciplinary surgical services capacity committee and individual surgeons.

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