Sokolovic E, Biro P, Wyss P, Werthemann C, Haller U, Spahn D, Szucs T
University Hospital Zurich, Department of Medical Economics, Switzerland.
Eur J Anaesthesiol. 2002 Aug;19(8):560-3. doi: 10.1017/s026502150200090x.
We investigated whether an increase in anaesthesia staffing to permit induction of anaesthesia before the previous case had ended ('overlapping') would increase overall efficiency in the operating room. Hitherto, the average duration of operating sessions was too long, thus impeding the timely commencement of physicians' ward duties.
The investigation was designed as a prospective, non-randomized, interrupted time-series analysis divided into three phases: (a) a baseline of 3.5 months, (b) a 2.5 month intervention phase, in which anaesthesia staffing was increased by one attending physician and one nurse, and (c) a further 2 months under baseline conditions. Data focussed on process management were collected from operating room staff, anaesthesia personnel and surgeons using a structured questionnaire collected daily during the entire study.
Turnover time between consecutive operations decreased from 65 to 52 min per operation (95% CI: 9; 17; P = 0.0001). Operating room occupancy increased from 4:28 to 5:27 h day-1 (95% CI: 50; 68; P = 0.005). The surgeons began their work on the ward 35 min (95% CI: 30; 40) later than before the intervention and their overtime increased from 22:36 to 139:50 h.
The time between surgical operations decreased significantly. Increased operating room efficiency owing to overlapping induction of anaesthesia allows more intense scheduling of operations. Thus, physicians and nurses can be released to spend more time with their patients in the ward. Improving the efficiency of the operating room alone is insufficient to improve human resource management at all levels of a surgical clinic.
我们研究了增加麻醉人员配置，以便在前一例手术结束前就开始诱导麻醉（“重叠式”）是否会提高手术室的整体效率。此前，手术时段的平均时长过长，从而妨碍了医生及时开始病房工作。
该研究设计为前瞻性、非随机、间断时间序列分析，分为三个阶段：（a）3.5个月的基线期，（b）2.5个月的干预期，在此期间麻醉人员配置增加一名主治医师和一名护士，以及（c）在基线条件下再持续2个月。通过在整个研究期间每日收集的结构化问卷，从手术室工作人员、麻醉人员和外科医生处收集聚焦于流程管理的数据。
连续手术之间的周转时间从每次手术65分钟降至52分钟（95%置信区间：9；17；P = 0.0001）。手术室占用时间从每天4:28小时增加至5:27小时（95%置信区间：50；68；P = 0.005）。外科医生开始病房工作的时间比干预前晚35分钟（95%置信区间：30；40），他们的加班时间从22:36小时增加至139:50小时。
手术之间的时间显著减少。由于麻醉诱导重叠而提高的手术室效率允许更紧凑地安排手术。因此，医生和护士能够腾出时间在病房陪伴更多患者。仅提高手术室效率不足以改善外科诊所各级别的人力资源管理。
