Strum D P, Vargas L G, May J H
Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
Anesthesiology. 1999 Apr;90(4):1176-85. doi: 10.1097/00000542-199904000-00034.
Operational inefficiencies in the use of operating rooms (ORs) are hidden by traditional measures of OR utilization. To better detect these inefficiencies, the authors defined two new terms, underutilization and overutilization, and illustrated how these measures might be used to evaluate the use of surgical subspecialty ORs. The authors also described capacity planning (optimizing surgical subspecialty block time allotments) using a minimal cost analysis (MCA) model.
The authors evaluated post hoc all surgeries performed over 6 yr at a large teaching hospital. To prepare utilization estimates, surgical records were categorized relative to budgeted OR block time for each subspecialty. Surgical cases beginning and ending during budgeted OR block time were categorized as budgeted utilization, budgeted time not used for surgery was underutilization, and cases beginning before/after budgeted block time were classified as overutilization. Cases that overlapped budgeted and nonbudgeted OR block time were parsed and the portions were assigned appropriately. Probability distributions were fitted to the historical patterns of surgical demand, and MCA block time budgets were estimated that minimized the costs of underutilization and overutilization for each subspecialty. To illustrate the potential savings if these MCA budgets were implemented, the authors compared actual operational costs to the estimated MCA budget costs and expressed the savings as a percentage of actual costs.
The authors analyzed data from 58,251 surgical cases and 10 surgical subspecialty blocks. Classic utilization for each block-day by surgical subspecialty ranged from 44-113%. Average daily block-specific underutilization ranged from 16 to 60%, whereas overutilization ranged from 4 to 49%.
Underutilization and overutilization are important measures because they may be used to evaluate the quality of OR schedules and the efficiency of OR utilization. Overutilization and underutilization also allow capacity planning using an MCA model This study indicated that the potential savings, if the MCA budgets were to be implemented, would be significant.
手术室（OR）使用中的运营低效率被传统的OR利用率衡量方法所掩盖。为了更好地发现这些低效率情况，作者定义了两个新术语，即利用不足和利用过度，并说明了如何使用这些指标来评估外科亚专科手术室的使用情况。作者还描述了使用最小成本分析（MCA）模型进行容量规划（优化外科亚专科手术时段分配）的方法。
作者对一家大型教学医院6年间进行的所有手术进行了事后评估。为了准备利用率估计值，根据每个亚专科的预算手术时段对手术记录进行分类。在预算手术时段内开始和结束的手术病例被归类为预算利用率，未用于手术的预算时间为利用不足，在预算手术时段之前/之后开始的病例被归类为利用过度。对与预算和非预算手术时段重叠的病例进行分析，并将各部分进行适当分配。将概率分布拟合到手术需求的历史模式上，并估计MCA手术时段预算，以尽量减少每个亚专科利用不足和利用过度的成本。为了说明实施这些MCA预算可能节省的费用，作者将实际运营成本与估计的MCA预算成本进行了比较，并将节省的费用表示为实际成本的百分比。
作者分析了58251例手术病例和10个外科亚专科手术时段的数据。每个手术亚专科每天的经典利用率在44%-113%之间。平均每天特定手术时段的利用不足率在16%至60%之间，而利用过度率在4%至49%之间。
利用不足和利用过度是重要的指标，因为它们可用于评估手术安排的质量和手术室利用的效率。利用过度和利用不足还允许使用MCA模型进行容量规划。本研究表明，如果实施MCA预算，潜在的节省将是巨大的。
