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  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 to 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.

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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 (ie, hospitals, day surgery centers, etc). Although the concepts are the same worldwide, the specific examples and their relevance to daily practice focus on US nonfederal facilities. 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. That is, evaluation of anesthesia care (productivity, costs, efficiency) within an OR is a surrogate for evaluation of OR management (productivity, costs, efficiency) and vice versa. The principles and processes for the evaluation discussed can be used equivalently for anesthesia OR care and OR management.

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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 performed 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 8 am to 4 pm on March 8.

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Staffed hours are hours that an anesthesia group schedules its providers to cover when not on call (eg, 8 am-4 pm).

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Staff assignment is the process of deciding who will take care of a specific patient on a specific day. Most assignments are typically made on the weekday before the date of surgery.

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For example, tomorrow, Dr White will be medically directing 3 certified registered nurse anesthetists in ORs 11, 12, and 13.

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Elective, Urgent, and Emergent Cases

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We are not aware of any one best answer as to what constitutes an elective, urgent, or emergent case.1 Still, differentiating among such cases is necessary to plan staffing. ...

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