The operational ramifications of a vascular surgical fellowship

Background: At our institution, a small, academic medical center, the Department of Surgery started a vascular surgery fellowship in August 2016. The vascular division consists of five board-certified vascular surgeons performing open and endovascular procedures. In this study, we hypothesized that the addition of a vascular surgery fellowship would lead to an increase in caseload, over-utilized time, over-scheduled time, and operating room workload along with a decrease in under-utilized time. Methods: Using WiseOR®, we extracted the following metrics: case volume, workload (elective time), after-hours (over-utilized time) and opportunity-unused (under-utilized time), a year before and after August 1, 2016. Monthly productivity was calculated: Productivity = (workload)/(allocated hours + 1.5*over-utilized time). Scheduling accuracy (actual < scheduled, ± 20% scheduled, and actual > scheduled) was extracted for all vascular surgeries. Scheduling analysis was categorized into three groups, under-schedule, over-schedule, and on-schedule; total operating room minutes, number of cases and their proportions (%) relative to the total logged for each group were calculated, before and after implementation. Statistical process control charts were used to analyze these metrics over time. Results: Monthly average over-utilized time increased by 79.2% (p < 0.05), total case volumes increased by 22.2% (p < 0.05), total opportunity-unused minutes decreased by 73.5% (p < 0.05). Monthly average workload increased by 10.4% (p < 0.05) without statistically significant changes in productivity. For scheduling error, monthly average percentage of over-schedule time increased by an absolute value of 12.4% (p < 0.05), over-schedule time (minutes) increased by 91.7% (p < 0.05), and over-schedule time increased by 34.2% (p < 0.05) without statistically significant changes in the under-schedule and on-schedule groups. Conclusions: A 5+2 vascular surgery fellowship does not change productivity and this can guide hospital administrators towards cost-effective management.