Abstract
Realistic scheduling of operating room cases decreases costs, optimizes utilization and improves staff and patient satisfaction. Currently limited data exists to establish anesthesia-controlled time benchmarks based on specific subspecialty service. In this multicenter retrospective analysis of cases performed during a 53 month period at two large multispecialty academic institutions, data were retrieved from the perioperative information systems at each center. Both induction and emergence times were calculated. We then determined mean and median anesthesia controlled times based on each subspecialty service and compared them to previously published anesthesia-controlled time data. We obtained data on 104,184 cases at hospital A, and 122,560 cases at Hospital B. For all specialties at hospital A and hospital B, median induction time was 16.0 min and 17.0 min, emergence time was 14.0 and 8.0 min, and total anesthesia controlled time was 31.0 min and 27.0 min respectively. There was considerable variability among different surgical specialties deviating from the previously established 30 min benchmark. Subspecialties with lower total anesthesia controlled times in both centers were pain, general surgery, gynecology, plastic surgery and urology. Subspecialties with higher total anesthesia controlled times in both centers included cardiac surgery, neurosurgery, transplant and vascular. Cardiac surgery had the highest total time of 60 min and 50 min at Hospital A and B respectively. Individual specialty-specific anesthesia controlled times should be used for case scheduling and to benchmark anesthesia performance.
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Dexter, F. E. R., Bayman, E. O., and Ledolter, J., Estimating surgical case durations and making comparisons among facilities: Identifying facilities with lower anesthesia professional fees. Anesth. Analg. 116(5):1103–1115, 2013.
Dexter, F., Ledolter, J., Tiwari, V., and Epstein, R. H., Value of a scheduled duration quantified in terms of equivalent numbers of historical cases. Anesth. Analg. 117(1):205–210, 2013.
Harders, M., Malangoni, M. A., Weight, S., and Sidhu, T., Improving operating room efficiency through process redesign. Surgery 140(4):509–514, 2006. discussion 14–6.
Eijkemans, M. J., van Houdenhoven, M., Nguyen, T., Boersma, E., Steyerberg, E. W., and Kazemier, G., Predicting the unpredictable: a new prediction model for operating room times using individual characteristics and the surgeon’s estimate. Anesthesiology 112(1):41–49, 2010.
Strum, D. P. V. L., and May, J. H., Surgical subspecialty block utilization and capacity planning: A minimal cost analysis model. Anesthesiology 90(4):1176–1185, 1999.
Overdyk, F. J., Harvey, S. C., Fishman, R. L., and Shippey, F., Successful strategies for improving operating room efficiency at academic institutions. Anesth. Analg. 86(4):896–906, 1998.
Ehrenwerth, J., Escobar, A., Davis, E. A., Watrous, G. A., Fisch, G. S., Kain, Z. N., et al., Can the attending anesthesiologist accurately predict the duration of anesthesia induction? Anesth. Analg. 103(4):938–940, 2006.
Zafar, S. U., Khan, F. A., and Khan, M., Standardization of anaesthesia ready time and reasons of delay in induction of anaesthesia. J. Pak. Med. Assoc. 56(3):112–115, 2006.
Kougias, P., Tiwari, V., Barshes, N. R., Bechara, C. F., Lowery, B., Pisimisis, G., et al., Modeling anesthetic times. Predictors and implications for short-term outcomes. J. Surg. Res. 180(1):1–7, 2013.
Dexter, F., Coffin, S., and Tinker, J. H., Decreases in anesthesia-controlled time cannot permit one additional surgical operation to be reliably scheduled during the workday. Anesth. Analg. 81(6):1263–1268, 1995.
Glossary of times used for scheduling and monitoring of diagnostic and therapeutic procedures. AORN J. 66(4):601–606, 1997.
Mazzei, W. J., Operating room start times and turnover times in a university hospital. J. Clin. Anesth. 6(5):405–408, 1994.
Donham, R. T., Defining measurable OR-PR scheduling, efficiency, and utilization data elements: The Association of Anesthesia Clinical Directors procedural times glossary. Int. Anesthesiol. Clin. 36(1):15–29, 1998.
Dufek, S., Gaucher, E., Gialanella, J., Kratochwill, E., Learned, D., Sonda, P., et al., The total quality process applied to the operating rooms and other clinical processes. Surgery 113(3):255–259, 1993.
Kanich, D. G., and Byrd, J. R., How to increase efficiency in the operating room. Surg Clin N Am 76(1):161–173, 1996.
Wright, I. H., Kooperberg, C., Bonar, B. A., and Bashein, G., Statistical modeling to predict elective surgery time. Comparison with a computer scheduling system and surgeon-provided estimates. Anesthesiology 85(6):1235–1245, 1996.
Kwok, A. C., Funk, L. M., Baltaga, R., Lipsitz, S. R., Merry, A. F., Dziekan, G., et al., Implementation of the World Health Organization surgical safety checklist, including introduction of pulse oximetry, in a resource-limited setting. Ann. Surg. 257(4):633–639, 2013.
Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A. H., Dellinger, E. P., et al., A surgical safety checklist to reduce morbidity and mortality in a global population. N. Engl. J. Med. 360(5):491–499, 2009.
Urman, R. D., Sarin, P., Mitani, A., Philip, B., and Eappen, S., Presence of anesthesia resident trainees in day surgery unit has mixed effects on operating room efficiency measures. Ochsner J 12(1):25–29, 2012.
Davis, E. A., Escobar, A., Ehrenwerth, J., Watrous, G. A., Fisch, G. S., Kain, Z. N., et al., Resident teaching versus the operating room schedule: An independent observer-based study of 1558 cases. Anesth. Analg. 103(4):932–937, 2006.
Eappen, S., Flanagan, H., and Bhattacharyya, N., Introduction of anesthesia resident trainees to the operating room does not lead to changes in anesthesia-controlled times for efficiency measures. Anesthesiology 101(5):1210–1214, 2004.
Broussard, D. M., and Couch, M. C., Anesthesia preparation time is not affected by the experience level of the resident involved during his/her first month of adult cardiac surgery. J. Cardiothorac. Vasc. Anesth. 25(5):766–769, 2011.
Unpublished Data. Department of Anesthesiology, Perioperative and Pain Medicine. Brigham and Women’s Hospital: Boston MA.
Raad, I. I., Hohn, D. C., Gilbreath, B. J., Suleiman, N., Hill, L. A., Bruso, P. A., et al., Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect. Control Hosp. Epidemiol. 15(4 Pt 1):231–238, 1994.
Overby, D. W., Kohn, G. P., Colton, K. J., Stavas, J. M., Dixon, R. G., Passannante, A., et al., Central venous line placement prior to gastric bypass improves operating room efficiency. ISRN Surg. 2012:816871, 2012.
Mariano, E. R., Chu, L. F., Peinado, C. R., and Mazzei, W. J., Anesthesia-controlled time and turnover time for ambulatory upper extremity surgery performed with regional versus general anesthesia. J. Clin. Anesth. 21(4):253–257, 2009.
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Kodali, B.S., Kim, K.D., Flanagan, H. et al. Variability of Subspecialty-Specific Anesthesia-Controlled Times at Two Academic Institutions. J Med Syst 38, 11 (2014). https://doi.org/10.1007/s10916-014-0011-7
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DOI: https://doi.org/10.1007/s10916-014-0011-7