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Impact of surgical sequencing on post anesthesia care unit staffing

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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.

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Author information

Authors and Affiliations

  1. Laboratory of Signal and Manufacturing Systems Analysis, Department Manufacturing System Management and Maintenance, Jean Monnet University of Saint Etienne, France

    Eric Marcon (Assistant Director, Professor)

  2. LASPI – IUT de Roanne, 20 avenue de Paris, City, Roanne, 42334, Cedex - France

    Eric Marcon (Assistant Director, Professor)

  3. Division of Management Consulting, Departments of Anesthesia and Health Management and Policy, University of Iowa, Iowa City, Iowa

    Franklin Dexter (Director, Professor)

Authors
  1. Eric Marcon
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  2. Franklin Dexter
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Correspondence to Eric Marcon.

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Marcon, E., Dexter, F. Impact of surgical sequencing on post anesthesia care unit staffing. Health Care Manage Sci 9, 87–98 (2006). https://doi.org/10.1007/s10729-006-6282-x

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  • DOI: https://doi.org/10.1007/s10729-006-6282-x

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