From Paper to Platform: Evaluating the Shift From Manual to Electronic Surgical Booking in a Large Hospital Setting

Transitioning from manual to electronic surgical booking systems has been shown to improve operating room efficiency in high-income settings. However, limited evidence exists from large public tertiary hospitals in low- and middle-income countries.

To compare surgical booking compliance, scheduling accuracy, and operational efficiency between manual and electronic booking systems in a large tertiary care hospital.

This retrospective comparative study was conducted in a 500-bed tertiary hospital in Egypt (NI hospital). Data were collected across three months: April 2025 (manual booking), June 2025, and July 2025 (electronic booking). A total of 3,268 elective surgical cases under general anesthesia across 17 specialties were analyzed. Booking compliance was defined as the proportion of elective cases booked ≥24 hours before surgery with complete data entry and approval per hospital policy. Exclusion criteria included emergency surgeries, procedures under local anesthesia, and same-day bookings. Operational metrics included scheduling conflicts, non-reserved cases, and delays.

Compliance improved from 64.7% (April, manual) to 83.2% (June, electronic) and 89.7% (July, electronic) (p<0.001). Across most specialties, significant gains in compliance and scheduling accuracy were observed, with minimal improvement in low-volume specialties such as plastic surgery and neurosurgery. Surgical volume increased by 31% post-implementation.

The electronic system reduced improperly scheduled cases by 14% (~126 cases/month), saving ~63 OR hours monthly. Estimated direct cost savings were 126,000 EGP/month. Staff feedback indicated smoother coordination, though no structured survey was conducted. Potential risks of electronic systems - data loss, system downtime, and cost - were mitigated through backup protocols and training. This was a single-center, short-term, retrospective study with no direct assessment of patient satisfaction or staff workload. Data entry bias during early adoption is possible.

Electronic booking significantly improved compliance and efficiency compared to manual methods in a large tertiary hospital. While promising, these findings require validation through prospective, multi-center studies with longer follow-up and inclusion of patient-centered outcomes.