Operating room managerial decision-making on the day of surgery with and without computer recommendations and status displays

Document Type


Peer Reviewed


Publication Date


NLM Title Abbreviation

Anesth Analg

Journal/Book/Conference Title

Anesthesia and Analgesia

PubMed ID


DOI of Published Version


Start Page


End Page



BACKGROUND: There are three basic types of decision aids to facilitate operating room (OR) management decision-making on the day of surgery. Decision makers can rely on passive status displays (e.g., big screens or whiteboards), active status displays (e.g., text pager notification), and/or command displays (e.g., text recommendations about what to do). METHODS: Anesthesiologists, OR nurses, and housekeepers were given nine simulated scenarios (vignettes) involving multiple ORs to study their decision-making. Participants were randomized to one of four groups, all with an updated paper OR schedule: with/without command display and with/without passive status display. RESULTS: Participants making decisions without command displays performed no better than random chance in terms of increasing the predictability of work hours, reducing over-utilized OR time, and increasing OR efficiency. Status displays had no effect on these end-points, whereas command displays improved the quality of decisions. In the scenarios for which the command displays provided recommendations that adversely affected safety, participants appropriately ignored advice. CONCLUSIONS: Anesthesia providers and nursing staff made decisions that increased clinical work per unit time in each OR, even when doing so resulted in an increase in over-utilized OR time, higher staffing costs, unpredictable work hours, and/or mandatory overtime. Organizational culture and socialization during clinical training may be a cause. Command displays showed promise in mitigating this tendency. Additional investigations are in our companion paper.


Appointments and Schedules, Computers, Decision Making, Health Personnel/organization & administration, Humans, Operating Room Information Systems/organization & administration, Operating Rooms/organization & administration, Patient Care Management/organization & administration, Personnel Staffing and Scheduling/organization & administration, Surgical Procedures, Operative

Published Article/Book Citation

Anesthesia and Analgesia, 105:2 (2007) pp.419-429. DOI:10.1213/01.ane.0000268539.85847.c9.

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