Block Utilization Issues: Why They Matter and What to Do About Them

It's a recurring theme we hear at nearly every hospital. Surgeons distrust - or actively refute the accuracy of - reported utilization statistics. Do they have good reason for this doubt? Regardless, hospitals continue to rely heavily on utilization statistics when making decisions about allocating block time. Is this a sensible thing for hospitals to do? What are the implications?

Variation in Utilization

Let's start with the accuracy of utilization statistics. Dexter et al. demonstrated in Anesthesia 2003 that utilization for blocks allocated to individual surgeons varies widely over time: 

"If during a 3-month period a surgeon's measured adjusted utilization is 65%, there is a 95% chance that the surgeon's average adjusted utilization is as low as 38% or as high as 83%."

Service-level blocks offer some variability protection, but often at their core, are really just a collection of either implicit or explicit sub-blocks with the same sort of variability mentioned above.

Playing Tetris

We also know from playing the game of Tetris that it is much easier to fill open block time with smaller chunks of time rather than larger chunks. As such, surgeons with longer-than-average case durations will, all else being equal, have lower utilization simply due to this Tetris-related challenge. This can lead to sub-optimal block allocation decisions.  How and why?

The "why" is that block allocation decisions are often not driven by a hospital's true strategic imperatives.  The "how" comes from a variety of sources, including:

• • acting on inaccurate utilization data
  • prioritizing utilization above something that might be more important; possibly contribution margin per OR hour?
  • failing to consider resource constraints (ICU or step-down unit capacities, robot rooms, C-arms, etc.)

Optimizing block allocation is a bigger topic than we'll cover in this blog post. 
The takeaways for now are:

• • Identify problems with your utilization reporting.
  • Fix them if you can.  If not, don't rely on the data or report it to surgeons.
  • Be thoughtful of the role utilization plays in your block allocation decisions.

For more information, check out a past post that outlines variables to consider in the optimization of OR utilization.