Dexter Franklin, Yue Jack C, Dow Angella J
Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa 52242, USA.
Anesth Analg. 2006 May;102(5):1491-500. doi: 10.1213/01.ane.0000202397.90361.1b.
We studied anesthesia times for diagnostic and interventional radiology using anesthesia billing data and paper radiology logbooks. For computerized tomography and magnetic resonance imaging procedures, we tried to predict future anesthesia times by using historical anesthesia times classified by Current Procedural Terminology (CPT) codes. By this method, anesthesia times were estimated even less accurately than operating room cases. Computerized tomography and magnetic resonance imaging had many different CPT codes, most rare, and CPT codes reflected organs imaged, not scanning times. However, when, anesthesia times were estimated by expert judgment, face validity and accuracy were good. Lower and upper prediction bounds were also estimated from the expert estimates. For interventional radiology, predicting anesthesia times was challenging because few CPT codes accounted for most cases. Because interventional radiologists scheduled their elective cases into allocated time, the necessary goal was not to estimate the time to complete each case but rather the time to complete each day's entire series of elective cases including turnover times. We determined the time of day (e.g., 4 pm) up to when interventional radiology could schedule so that on 80% of days the anesthesia team finishes no later than a specified time (e.g., 6 pm). Both diagnostic and interventional radiology results were similarly less accurate when Version 9 of the International Classifications of Diseases' procedure codes was used instead of CPT.
我们利用麻醉计费数据和纸质放射学日志研究了诊断性和介入性放射学的麻醉时间。对于计算机断层扫描和磁共振成像程序,我们试图通过使用按现行程序术语(CPT)代码分类的历史麻醉时间来预测未来的麻醉时间。通过这种方法,麻醉时间的估计甚至比手术室病例更不准确。计算机断层扫描和磁共振成像有许多不同的CPT代码,大多数都很罕见,而且CPT代码反映的是成像器官,而非扫描时间。然而,当通过专家判断来估计麻醉时间时,表面效度和准确性都很好。还根据专家估计值估算了预测下限和上限。对于介入性放射学,预测麻醉时间具有挑战性,因为大多数病例仅由少数CPT代码涵盖。由于介入放射科医生将他们的择期病例安排在分配的时间内,所以必要的目标不是估计完成每个病例的时间,而是估计完成包括周转时间在内的每天整个择期病例系列的时间。我们确定了介入性放射学可以安排病例的截止时间(例如,下午4点),以便在80%的日子里,麻醉团队不迟于指定时间(例如,下午6点)完成工作。当使用《国际疾病分类》第9版的程序代码而非CPT时,诊断性和介入性放射学的结果同样不太准确。