Dexter Franklin, Lee John D, Dow Angella J, Lubarsky David A
Department of Anesthesia and Health Management and Policy, Division of Management Consulting, University of Iowa, IA 52242, USA.
Anesth Analg. 2007 Aug;105(2):430-4. doi: 10.1213/01.ane.0000268540.85521.84.
We investigated whether, without prompting, anesthesiologists tend to make managerial decisions to increase the clinical work per unit time of the sites to which they are assigned during their scheduled time present. Although a sound basis for decision-making involving individual ORs, the heuristic is often suboptimal economically when applied to decisions involving multiple ORs.
Two studies were performed at one hospital. 1) A retrospective analysis was made of anesthesiologists' managerial decisions when caring for sequential lists of patients. 2) Patients' and surgeons' waiting on nights and weekends were studied before/after education on optimal decision-making.
In a companion article, we showed that clinicians tended to make decisions that increased the clinical work per unit time at each moment in each OR, even when doing so resulted in an increase in overutilized OR time, higher staffing costs, unpredictable work hours, and/or mandatory overtime. The current studies show that such efforts to work fast cannot be explained as a consequence of efforts to reduce surgeon and patient waiting. Rather, the heuristic followed is consistent with increasing one's personal clinical work per unit time at one's assigned anesthetizing location.
我们调查了麻醉医生在没有提示的情况下，是否倾向于做出管理决策，以增加他们在预定出勤时间内所负责手术间的单位时间临床工作量。尽管这种决策方式是涉及单个手术室的合理决策基础，但在应用于涉及多个手术室的决策时，这种启发式方法在经济上往往并非最优。
在一家医院进行了两项研究。1）对麻醉医生在护理连续患者名单时的管理决策进行回顾性分析。2）在进行关于最优决策的教育前后，对夜间和周末患者及外科医生的等待情况进行研究。
1）麻醉医生的决策导致他们单位时间的临床工作量增加，而不是患者等待时间减少。2）矛盾的是，夜间和周末的这种做法导致患者和外科医生等待时间增加。在接受关于不同病例分配方式的教育后，决策没有改变。
在一篇配套文章中，我们表明临床医生倾向于做出决策，增加每个手术室每时每刻的单位时间临床工作量，即使这样做会导致手术室使用时间过度增加、人员配置成本更高、工作时间不可预测和/或强制加班。当前的研究表明，这种快速工作的努力不能解释为是为了减少外科医生和患者等待时间的结果。相反，所遵循的启发式方法与增加个人在指定麻醉地点的单位时间临床工作量是一致的。
