The operational ramifications of a first-in first-out bump policy

Timothy Wong, Anna G. Quinlan, Elie Sarraf, Brian H. Irwin, Andrew C. Stanley, Hung T. Do, David C. Novak, Mitchell H. Tsai

Research output: Contribution to journalArticlepeer-review


Background: The majority of institutions follow a protocol whereby urgent add-on cases are scheduled into a designated operating room. An alternative method is the bump model, whereby urgent cases displace previously scheduled cases in a fully booked operating suite without a designated acute care room. Institutions may refrain from employing the latter model due to increased tardiness for bumped cases. Here, we propose a modification to the traditional bump policy termed first-in, first-out (FIFO) bump policy, whereby bumped cases from multiple operating rooms are queued and released sequentially in accordance with their originally scheduled start time. The operational team at the University of Vermont Medical Center implemented this policy in a subset of eligible operating rooms during a challenging day. In this paper, we analyze the differences in operating room tardiness between the traditional bump policy and the FIFO bump policy implemented on this day at our institution. Materials and methods: We extracted the scheduled and actual start times of all operating room cases provided by the Department of Anesthesiology for January 18, 2019 using WiseOR® (Palo Alto, CA). Microsoft Excel (Redmond, WA) was used for data entry. We looked at operating room tardiness for the cases on that day, which followed first-in, first-out policy. We also simulated two other potential scenarios, which followed the traditional bump policy, and calculated their total tardiness. Results: The total tardiness for FIFO policy, tradition bump scenario 1, and traditional bump scenario 2 were 1188 min, 1256 min, and 1417 min respectively. In the FIFO scenario, total tardiness was lower compared to the projected traditional bump policy scenarios. Conclusions: This case study demonstrates that the FIFO scenario resulted in a lower amount of total tardiness compared with bumping one surgeon or service for the entire day. Although the FIFO scenario resulted in case delays for two different surgeons, the overall tardiness was lower than having a single surgeon bumped for the entire day, as would be in the case of the traditional bump scenario. This paper provides the theoretical framework for future large-scale studies and potential implementation of FIFO policy.

Original languageEnglish (US)
Article number100302
JournalPerioperative Care and Operating Room Management
StatePublished - Mar 2023

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine
  • Medical–Surgical
  • Anesthesiology and Pain Medicine


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