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Health Care Management Science

, Volume 9, Issue 1, pp 87–98 | Cite as

Impact of surgical sequencing on post anesthesia care unit staffing

  • Eric Marcon
  • Franklin Dexter
Article

Abstract

This paper analyzes the impact of sequencing rules on the phase I post anesthesia care unit (PACU) staffing and over-utilized operating room (OR) time resulting from delays in PACU admission. The sequencing rules are applied to each surgeon's list of cases independently. Discrete event simulation shows the importance of having a sufficient number of PACU nurses. Sequencing rules have a large impact on the maximum number of patients receiving care in the PACU (i.e., peak of activity). Seven sequencing rules are tested, over a wide range of scenarios. The largest effect of sequencing was on the percentage of days with at least one delay in PACU admission. The best rules are those that smooth the flow of patients entering in the PACU (HIHD (Half Increase in OR time and Half Decrease in OR time) and MIX (MIX OR time)). We advise against using the LCF (Longest Cases First) and equivalent sequencing methods. They generate more over-utilized OR time, require more PACU nurses during the workday, and result in more days with at least one delay in PACU admission.

Keywords

Operating Room and PACU: schedule Optimization Staffing Economics 

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Copyright information

© Springer Science + Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Laboratory of Signal and Manufacturing Systems Analysis, Department Manufacturing System Management and MaintenanceJean Monnet University of Saint EtienneFrance
  2. 2.LASPI – IUT de RoanneCity, RoanneCedex - France
  3. 3.Division of Management Consulting, Departments of Anesthesia and Health Management and PolicyUniversity of IowaIowa City

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