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Healthcare Engineering Fieldwork.

25 April 2013

Most of my work is sitting at a computer typing out code or processing data from one giant array to another, trying to formulate it in a way readable by the second-rate code I write. Building simulations of systems. But everyone once in a while, I get to go out, into the field, and do some cool observations. Science fieldwork is the sexy side of science. It’s the gorillas-in-the-mist, pigs-in-space side of science. Going out into the world and examining things as they really are. Seeing how nature and the elements interact. I know people who do truly exciting fieldwork, stomping through African jungles and savannahs, diving in Fiji. I even know people who are applying to astronaut programs to do science in space. It’s really cool.

By comparison, my fieldwork is pretty dull. Instead of typing at my computer in the hospital basement, I go up to the surgical tower and strap on a bunny suit, so that I can observe surgeries. Sometimes, I go into clinics and emergency departments. The last couple of years I was doing that in New England at ECU’s affiliated hospital. But I didn’t do much of that fieldwork myself. I had research assistants who took the data and monitored the processes. Most of my work on that project was typing at the computer.

But today I got to spend about three and a half hours in real-world, honest-to-Pete observational science-mode in the field in MECMC’s operating rooms. I’ve visited before for a minute or two, taking a look around. It’s exciting, and can be a little intimidating. Since I’m not a regular OR worker, I don’t own scrubs. This means I need to put on a disposable “bunny suit” so that I don’t contaminate the clean areas. My goal for this project is to understand how OR turnaround is accomplished.

OR turnaround is the process of cleaning the room after one patient, and preparing it for another. Our goal is to accomplish this task as quickly as possible, because the operating rooms are one of the main financial drivers of any hospital. It costs thousands of dollars an hour to keep an OR in service. OR idle time is phenomenally expensive, both in direct costs and in opportunity costs for patients who could be being seen. But of course, it isn’t just money that drives it (and I don’t even know the real numbers, nor will I include them in my simulations). Believe it or not, hospitals and health care professionals really do care about providing the best care to the most patients. It’s not entirely cash-driven. Most surgeons like to operate because they like fixing people, not just because they collect airplanes.

OR idle time means fewer surgeries performed, which means a longer wait for surgeries that are performed, which means that people suffer while waiting for surgery. The whole field of medicine exists to claim ground in the battle against death and suffering. Every minute an OR is ready for a patient that isn’t in it, is time and treasure wasted in that battle. So my job is to help figure out where we can eliminate waste and duplication in the effort of turning over an OR. Everybody wins. When we can do more surgeries, we relieve more suffering. We generate more revenue. And we can reduce the cost of individual procedures through economies of scale.

So I made observations today. Which is one of the first steps of doing science. I’m not even taking data yet. Just observing the process so that I can understand who is doing what, what the jobs are, and what has to be done in what order to prepare the OR for the next patient. One thing was fairly obvious from the get-go. Sometimes, surgeons (or anesthesiologists) will run two ORs at the same time, so that one patient can be prepped while the other is still in surgery. This maximizes the surgeon’s productivity by ensuring that a patient is waiting for the knife at all times.

However, it also means that ORs sit idle while waiting for surgeons (or anesthesiologists) to become available. There was a time when a surgeon’s time was probably more valuable than the ORs. But that’s no longer the case, by a couple of orders of magnitude. It would be far less expensive to hire a few more surgeons, and pay them to wait, and keep those ORs clicking. Of course, if you’ve ever met a surgeon who will tolerate waiting in a professional context, you should write in to Ripley’s.

So, there’s today’s little primer on Healthcare Engineering Fieldwork. This is just a tiny corner of the world of it, of course. MECMC has partner hospitals all over the country and the world. It would be exciting to be able to go and study them, deploying simulation to the far reaches of the globe. For now, my fieldwork is in a local field. But that’s no less exciting. I get to watch the real world of medicine unfold in front of me. And I get to play a role in making it better. It’s exciting and humbling to be able to do that here. I love this job. This place. This life.

7 Comments leave one →
  1. Syd permalink
    25 April 2013 17:22

    That sounds like great stuff. And may be applicable for many OR’s in other areas too. I wonder how some of the US OR compare with those in other countries for availability and wait times.

  2. Bashir permalink
    25 April 2013 20:12

    You should get some scrubs and a stethoscope. Just because.

  3. 29 April 2013 07:00

    Hi Dr24hours!!! I failed to keep a link to your blog, and decided to find it this morning. It is so good to see that you are still blogging, and that it is such a diverse and interesting blog. I am going to link so that I can visit more often.

    Oh, and I am returning to healthcare. In a somewhat more pedestrian role than yours, but I am dee-lighted.

    Mary Christine

  4. becca permalink
    29 April 2013 17:14

    You should get scrubs and a magnifying glass, and explain you are the sherlock holmes of the ER. Also, you should get those filthy bugger to stop spreading MRSA. 😉

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