Pandit J J, Westbury S, Pandit M
Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK.
Anaesthesia. 2007 Sep;62(9):895-903. doi: 10.1111/j.1365-2044.2007.05174.x.
While numerous reports have sought ways of improving the efficiency of surgical operating lists, none has defined 'efficiency'. We describe a formula that defines efficiency as incorporating three elements: maximising utilisation, minimising over-running and minimising cancellations on a list. We applied this formula to hypothetical (but realistic) scenarios, and our formula yielded plausible descriptions of these. We also applied the formula to 16 consecutive elective surgical lists from three gynaecology teams (two at a university hospital and one at a non-university hospital). Again, the formula gave useful insights into problems faced by the teams in improving their performance, and it also guided possible solutions. The formula confirmed that a team that schedules cases according to the predicted durations of the operations listed (i.e. the non-university hospital team) suffered fewer cancellations (median 5% vs 8% and 13%) and fewer list over-runs (6% vs 38% and 50%), and performed considerably more efficiently (90% vs 79% and 72%; p = 0.038) than teams that did not do so (i.e. those from the university hospital). We suggest that surgical list performance is more completely described by our formula for efficiency than it is by other conventional measures such as list utilisation or cancellation rate alone.
虽然众多报告都在探寻提高外科手术安排效率的方法，但尚无一份报告对“效率”进行定义。我们描述了一个公式，将效率定义为包含三个要素：使利用率最大化、使超时情况最小化以及使手术安排中的取消情况最小化。我们将此公式应用于假设（但现实）的场景，该公式对这些场景给出了合理的描述。我们还将该公式应用于来自三个妇科团队（两所大学医院的两个团队和一所非大学医院的一个团队）的连续16份择期手术安排。同样，该公式为各团队在提高绩效方面所面临的问题提供了有益的见解，也指导了可能的解决方案。该公式证实，根据所列出手术的预计时长来安排病例的团队（即非大学医院团队）取消情况较少（中位数分别为5%，而另外两个团队为8%和13%），手术安排超时情况也较少（分别为6%，而另外两个团队为38%和50%），并且比不这样做的团队（即大学医院的团队）效率高得多（分别为90%，而另外两个团队为79%和72%；p = 0.038）。我们认为，与仅用诸如手术安排利用率或取消率等其他传统指标相比，我们的效率公式能更全面地描述手术安排的绩效。
