Dr. Elena Bafani - From Paper to Pixels: Digital Innovations for the Anesthesia Schedule and the Future of OR Operations
With Dr. Elena Bafani · hosted by Dr. Todd Ponsky
Chapter 1 of 10 · Fundamentals
Introduction
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What the experts said
The operating room generates 50-70% of hospital revenue, making it shocking that a large organization relied on pen and paper processes in the post-COVID era.
Children's Hospital of Philadelphia (CHOP) manages OR scheduling manually using magnets on a physical board, with individual magnets representing cases and anesthesiologists indicated by magnet orientation (upside down or sideways for pre-call/post-call status).
Boston Children's Hospital anesthesia department manages 77 attendings, 30 CRNAs, 18 fellows, and 25 rotating residents monthly across 45-47 locations including 24 main campus ORs plus satellites at radiology, GI suite, Dana-Farber, and Brigham.
Physical whiteboards require manual data input, are only updated when floor runners are physically present, become outdated quickly in fast-paced ORs, and are limited to single physical locations preventing remote access.
Epic is excellent for medical documentation and billing but is not designed for real-time operational scheduling or resource management, necessitating custom whiteboard solutions.
Boston Children's Hospital is unique in requiring an anesthesiologist to start every OR case, unlike most institutions that use staggered 7:30 AM starts.
Anesthesiologists have highest focus during induction and emergence while surgeons concentrate during procedures, creating opposite workflow schedules with anesthesia busiest at case beginnings and ends.
When the electronic system experiences glitches lasting more than 5 minutes, it creates a general crisis in the OR, demonstrating the system's transition from useful tool to essential infrastructure.
The electronic whiteboard is loaded at least 1,000 times per week based on October usage data, indicating essential integration into workflow.
The electronic scheduling system reduced schedule creation time from 2-3 hours of manual counting and assignment to a streamlined automated process with earlier release times (12:00 PM vs. 3:00 PM).
ACGME requires residents to complete specific case minimums including 5 neonates and 100 patients between 2-10 years old before graduation, which the system tracks automatically and flags deficiencies.
Planned automated daily emails at 4:00 PM will connect surgeons, anesthesiologists, and nurses assigned to specific rooms, replacing failed in-person huddle attempts and enabling room-specific communication about next-day needs.
The transparent call schedule system eliminated chronic complaints by making every physician's call requirements visible and prorated based on FTE status, allowing staff to take ownership rather than feeling victimized.
The system allows manual overrides on almost all whiteboard fields if Epic or other connected systems go down, maintaining functionality during electronic shutdowns.
Epic is a source of data but not an intelligence platform, requiring local solutions like this whiteboard system that integrate multiple data sources including enterprise resource platforms for staffing, finance, and supply chain.
The holiday call schedule uses objective ranked preferences with historical data for three major holidays to maximize individual satisfaction by protecting those who least want specific holidays and preventing perpetual assignment of least desirable shifts.
The system aims to assign every division member one of their top 3 holiday choices and doubles up shifts on holiday weekends to minimize total holiday work days despite increased busyness.
Data became the most powerful tool by killing complaints (objective facts replace subjective feelings), protecting culture through enforced transparency and equity, and transforming administrative roles from constant mediation to strategic management.
Average nursing experience in the OR is approximately 3 years, creating challenges for complex system transitions and information tracking.
Summer vacation policy allows all staff 2 weeks off with requests entered into a system showing daily staffing levels and requirements, enabling self-service conflict resolution and transparent capacity management.
The system now contains 2 years of accumulated data that can be analyzed by AI to identify operational patterns, bottlenecks, and improvement opportunities.
Dr. Bafani completed medical school in Bucharest, Romania, anesthesia residency at Saint Luke's Roosevelt Hospital in New York, and pediatric anesthesia fellowship at Boston Children's Hospital, earning a 20-year service pin.
Only 5% of the population embraces new ideas according to data on individual attitudes about change, creating immediate resistance to electronic board initiatives.
National data indicates that autonomy over one's schedule is a top 3 driver of job satisfaction, and lack of schedule control is the fastest route to burnout.
Boston Children's Hospital previously could not hire anesthesiologists but now sees faculty expansion due to improved culture where trainees observe satisfied faculty and choose to join, credited to leadership empowerment of operational innovators.