Dexter Elisabeth U, Dexter Franklin, Masursky Danielle, Garver Michael P, Nussmeier Nancy A
Section of General Thoracic Surgery, Department of Surgery, State University of New York Upstate Medical University, Syracuse, New York, USA.
Anesth Analg. 2009 Apr;108(4):1257-61. doi: 10.1213/ane.0b013e31819a6dd4.
The economic costs of reducing first case delays are often high, because efforts need to be applied to multiple operating rooms (ORs) simultaneously. Nevertheless, delays in starting first cases of the day are a common topic in OR committee meetings.
We added three scientific questions to a 24 question online, anonymous survey performed before the implementation of a new OR information system. The 57 respondents cared sufficiently about OR management at the United States teaching hospital to complete all questions.
The survey revealed reasons why personnel may focus on the small reductions in nonoperative time achievable by reducing tardiness in first cases of the day. (A) Respondents lacked knowledge about principles in reducing over-utilized OR time to increase OR efficiency, based on their answering the relevant question correctly at a rate no different from guessing at random. Those results differed from prior findings of responses at a rate worse than random, resulting from a bias on the day of surgery of making decisions that increase clinical work per unit time. (B) Most respondents falsely believed that a 10 min delay at the start of the day causes subsequent cases to start at least 10 min late (P < 0.0001 versus random chance). (C) Most respondents did not know that cases often take less time than scheduled (P = 0.008 versus chance). No one who demonstrated knowledge (C) about cases sometimes taking less time than scheduled applied that information to their response to (B) regarding cases starting late (P = 0.0002).
Knowledge of OR efficiency was low among the respondents working in ORs. Nevertheless, the apparent absence of bias shows that education may influence behavior. In contrast, presence of bias on matters of tardiness of start times shows that education may be of no benefit. As the latter results match findings of previous studies of scheduling decisions, interventions to reduce patient and surgeon waiting from start times may depend principally on the application of automation to guide decision-making.
减少首例手术延误的经济成本通常很高，因为需要同时在多个手术室开展工作。然而，当日首例手术开始时的延误是手术室委员会会议上的常见话题。
在新的手术室信息系统实施之前，我们在一份包含24个问题的在线匿名调查问卷中增加了3个科学问题。57名受访者对美国教学医院的手术室管理非常关注，因此完成了所有问题。
该调查揭示了工作人员可能关注通过减少当日首例手术的迟到时间来实现非手术时间小幅减少的原因。（A）受访者缺乏关于减少手术室过度使用时间以提高手术室效率的原则的知识，因为他们对相关问题的回答正确率与随机猜测无异。这些结果与之前比随机猜测更差的回答结果不同，这是由于手术当天做出增加单位时间临床工作量的决策存在偏差所致。（B）大多数受访者错误地认为当日开始时延误10分钟会导致后续手术至少推迟10分钟开始（与随机概率相比，P < 0.0001）。（C）大多数受访者不知道手术时间通常比预定时间短（与概率相比，P = 0.008）。在知晓手术时间有时比预定时间短（C）的人中，没有人将该信息应用于他们对手术开始延迟（B）的回答中（P = 0.0002）。
手术室工作人员对手术室效率的了解程度较低。然而，明显不存在偏差表明教育可能会影响行为。相比之下，在开始时间延迟问题上存在偏差表明教育可能没有益处。由于后一结果与之前关于排班决策的研究结果相符，减少患者和外科医生从开始时间起等待时间的干预措施可能主要取决于应用自动化来指导决策。
