Epstein Richard H, Dexter Franklin, Traub Rodney D
Department of Anesthesiology, Jefferson Medical College, Philadelphia, PA, USA.
J Perianesth Nurs. 2002 Apr;17(2):84-8. doi: 10.1053/jpan.2002.31840.
When each nurse in the Phase I setting is caring for the maximum number of patients allowed by hospital staffing standards (typically 2 per ASPAN standards), patients may have to be held in the OR until a PACU nurse becomes available. Previously, the authors described a statistical method to determine the process of scheduling existing nurses without increasing staffing hours (Dexter et al. Anesth Analg. 92:947-949, 2001). The end result was to minimize the percentage of future workdays during which at least one patient would wait in his or her OR for Phase I PACU admission. In this study, the authors performed a statistical power analysis to determine how many months of PACU workload data are needed to optimize PACU staffing by using this "set covering" algorithm. One year (232 workdays) of data was available from a PACU employing up to 10 nurses working a total of 72 clinical hours a day. The data were divided into 2 subsets. Using the first subset, which varied in size between 20 and 140 days of data, the authors identified the optimal staffing solutions. These solutions were tested on the second subset of data. This process then was repeated thousands of times. There was a marked improvement in the performance of the staffing solutions at preventing "PACU hold" by increasing from 20 to 80 historical workdays of data, a slight but statistically significant improvement between 80 and 100 workdays, but no significant improvement in further increasing the number of workdays of data. PACU nurse managers should use at least 4 months of data when choosing a staffing solution to minimize the chance of patients waiting in ORs for PACU admission. Tampering with PACU staffing more often than every 4 months is unlikely to result in improvements in OR efficiency and may harm recruitment and retention of nursing staff.
在第一阶段设置中，当每位护士按照医院人员配备标准护理允许的最大数量患者时（通常按照美国麻醉后护理协会标准为每位护士护理2名患者），患者可能不得不留在手术室，直到有麻醉后护理单元（PACU）护士可用。此前，作者描述了一种统计方法，用于在不增加人员配备时长的情况下确定现有护士的排班流程（德克斯特等人，《麻醉与镇痛》，92:947 - 949，2001年）。最终结果是尽量减少未来工作日中至少有一名患者在手术室等待进入第一阶段PACU的百分比。在本研究中，作者进行了统计功效分析，以确定需要多少个月的PACU工作量数据，才能通过使用这种“集合覆盖”算法来优化PACU人员配备。从一个雇用多达10名护士、每天总共工作72个临床小时的PACU可获取一年（232个工作日）的数据。这些数据被分为两个子集。作者使用第一个子集（数据量在20至140天之间变化）确定了最佳人员配备方案。这些方案在第二个数据子集上进行了测试。然后这个过程重复了数千次。通过将数据量从20个历史工作日增加到80个，在防止“PACU滞留”方面，人员配备方案的性能有了显著提高；在80至100个工作日之间有轻微但具有统计学意义的提高，但进一步增加数据工作日数量则没有显著改善。PACU护士管理人员在选择人员配备方案时应至少使用4个月的数据，以尽量减少患者在手术室等待进入PACU的可能性。比每4个月更频繁地调整PACU人员配备不太可能提高手术室效率，还可能损害护理人员的招聘和留用。
