A day in the life of a perioperative leader:
6:30am: Review a well-organized OR schedule
7:45am: First cases start on time, and things are on track
9:30am: Some cases take longer than scheduled, other cases are delayed — the schedule starts to slip
12:30pm: Snowball effect with multiple rooms running late
1:30pm: The original plan is out the window; the OR is understaffed and focused on firefighting
Every perioperative leader knows this story. The day starts with a well-organized OR schedule. But, by midday, timelines have slipped. Cases run late. Rooms sit unexpectedly empty. Staff scrambles to adjust.
Why? Because the assumptions baked into the schedule were wrong from the start.
One of the most consistent yet overlooked sources of OR inefficiency is inaccurate case duration estimates. In many cases, surgeons provide their own time estimates, which schedulers use to build the schedule. In others, schedulers rely on tools that calculate a basic average from the surgeon’s most recent cases. But whether the estimate is based on experience or simplistic algorithms, it rarely reflects the reality of what happens in the OR.
The resulting impact can be profound: sometimes resource underutilization, other times delays leading to overtime. Inaccurate scheduling doesn’t impact just one case at a time — its impact creates cascading effects that compound throughout the entire day.
Check out our case study on How Health First Optimized Flip Rooms to Increase Case Volume by 33% and added two cases per day to one surgeon’s schedule.
Why case duration estimates matter so much
Accurate case duration estimates are foundational for operational throughput, not just in the OR, but across perioperative departments.
- Staffing Plans: ensuring the right teams are available at the right times, minimizing overtime and idle periods
- Perioperative Coordination: patient throughput and coordination in both Pre-op and PACU
- Room Sequencing and Utilization: balancing case lengths across rooms to optimize daily throughput and avoid bottlenecks
Without trustworthy case durations, OR scheduling turns into a series of educated guesses, forcing teams to react to problems throughout the day rather than running the OR proactively and predictably.
The cost of getting it wrong
While a few minutes here or there may seem inconsequential, even minor case duration errors often create major operational challenges across the schedule.
When cases are over-scheduled — scheduled for more time than they actually require — it can lead to:
- Underutilized OR time due to unnecessary idle time that could have supported additional procedures or urgent add-on cases
- Staff downtime that strains productivity
When cases are under-scheduled — scheduled for less time than they actually require — it can lead to:
- Delays for subsequent cases, which frustrate surgeons, staff, and patients
- Unexpected overtime for OR staff
- Staffing complexities due to compounding delays
- Added patient stress due to unexpected delays
In either case, inaccurate case durations aren’t just a scheduling inconvenience; they create systemic friction that silently undermines the entire day’s efficiency. Understanding the hidden costs of inaccurate case durations is only the first step. The bigger question is why this keeps happening, even with modern tools, experienced teams, and strong processes.
In our next post, we’ll dive deeper into the structural reasons why accurate OR scheduling remains so difficult today and what a better path forward looks like. (Spoiler: it’s not about working harder; it’s about working smarter with better data.)
Check out our case study on How Health First Optimized Flip Rooms to Increase Case Volume by 33% and added two cases per day to one surgeon’s schedule.