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KEY POINTS

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KEY POINTS

  1. Efforts to increase anesthesia group productivity are essentially indistinguishable from efforts to increase the efficiency of use of operating room (OR) time and vice versa.

  2. To describe operational reality, the mathematics of service-specific staffing is based on the surgeon and patient having open access to OR time on the workday of their choosing.

  3. Scheduling cases and making decisions on the day of surgery to increase OR efficiency are worthwhile interventions to increase anesthesia group productivity. However, the most important step, by far, is the allocation of OR time (ie, the planning of service-specific staffing) appropriately 2-3 months before the day of surgery.

  4. Reducing surgical, turnover times, or first case of the day start delays generally provides small increases in anesthesia group productivity, but results vary widely because they are highly sensitive to both the OR allocations (ie, staffing) and the appropriateness of those OR allocations.

  5. To use OR allocations in practice on the day of surgery, data needed include the forecasted time remaining in ongoing cases. These forecasts affect decisions such as calling for the next patient, moving cases among rooms, staff relief, and scheduling add-on cases.

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INTRODUCTION

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This chapter focuses on the determinants of anesthesia labor productivity and costs in operating rooms. It is intended to help physicians apply evidence-based management as they plan staffing for their facilities (hospitals, day surgery centers, etc). Both productivity and the cost of providing operating room (OR) anesthesia care are inextricably linked to the choices of how many ORs to open at the start of the day and how to schedule cases into those locations.

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The decisions of this chapter are of considerable importance to hospitals because anesthesia group productivity is linked to the difference between the gross revenue (reimbursement) received by the hospital for surgery and the associated variable costs (eg, supplies, implants). Net revenue is used to pay for the substantial fixed costs such as the electronic medical record systems and operating and maintenance expenses of the physical plant. At hospitals where anesthesia providers are salaried employees, low productivity results in the need to hire more providers than otherwise necessary, resulting in greater costs. At hospitals where anesthesia providers receive direct compensation from insurers for their professional fees, low productivity often results in the need for the hospital to provide institutional support to the anesthesia group.

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DEFINITIONS

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STAFF SCHEDULING AND ASSIGNMENT

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Staff scheduling is the process of deciding which anesthesia providers work each shift on each day. Staff scheduling for a future date usually is done before the surgical cases to be performed on that date have been scheduled.

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For example, an anesthesia group creates its work schedule 2 months in advance. Drs Jones and Green are scheduled to work from 8 a.m. to 4 p.m. on March 8.

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Staffed hours are hours ...

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