Study deems EHR manipulation “elephant in the room” for OR scheduling accuracy

Editor's Note

Reducing surgeon manipulation of electronic health record (EHR) OR scheduling systems can improve efficiency, save resources, and enhance service to patients, according to data published in the March/April issue of the Journal of Healthcare Management.

Although predictive models using EHR and machine learning improve accuracy compared to traditional OR scheduling, the newer systems are still subject to manipulation by surgeons or schedulers, the researchers note, calling this manipulation “the elephant in the room” that is often overlooked. Their study, performed in three hospitals within the same tertiary care center, aimed to evaluate whether minimizing the manipulation of OR time predicted by the EHR system could improve scheduling accuracy.

To achieve these aims, the researchers split 8,821 operations into two groups. Group 1 consisted of procedures that were time-manipulated in the five months prior to the trial, and Group 2 consisted of procedures performed during the trial period (April to August 2022). For the latter group, surgeons were instructed not to manipulate the operative time predicted for their cases predicted by the Epic EHR. Notable findings include:

• The percentage of manipulation was significantly reduced from 19.8% in Group 1 to 7.6% in Group 2.
• The accuracy of scheduled cases (defined by a total, wheels in–wheels out case length within ±30 min or ±20% of the scheduled time for procedures lasting ≥ or <150 min, respectively) significantly increased from 41.7% in Group 1 to 47.9% in Group 2.
• The under-scheduled case percentage showed a significant reduction (38.9% vs. 31.8% in Groups 1 and 2, respectively).
• The percentage of overscheduled cases showed no significant difference (19.2% vs. 20.2% in Groups 1 and 2, respectively).
• In Group 2, there was an 18% reduction in total inaccurate OR hours.

“The current study presents evidence that can help to change surgeons’ views and practices related to OR scheduling through an EHR system and can encourage organizations to implement strategies like those presented here,” the researchers conclude.