Dexter Franklin, Epstein Richard H
Department of Anesthesia , University of Iowa, Iowa City, IA 52242, USA.
Anesth Analg. 2009 Apr;108(4):1262-7. doi: 10.1213/ane.0b013e31819775cd.
Analysts and clinicians sitting in operating room (OR) committee meetings cannot evaluate rapidly whether a suggested idea to reduce delays in first case of the day starts can be beneficial economically.
Three years of data were used from a six OR outpatient surgery facility. The cost reduction from reducing the tardiness of start of first cases of the day was calculated using the method of McIntosh et al. (Anesth Analg 2006;103:1499-516), limited to ORs with at least 8 h of cases and turnovers. Results were then reported per minute reduction in tardy first case of the day starts as an approximation for rapid use in meetings.
Each 1.0 min reduction in the tardy starts of first cases of the day in ORs with more than 8 h of cases and turnovers resulted overall in 1.1 +/- 0.1 min reduction in regularly scheduled labor costs (mean +/- se). This result was close to the 1.2 min obtained using an entirely different (simulation) method performed previously for OR time reductions. Secondary analyses confirmed that assumptions were satisfied at the facility, thereby reducing the chance that results are biased. For example, the proportions of the variance in tardiness attributable to anesthesiologists and specialties were only 1% and 3%, respectively, and there were no significant differences in tardiness among the 85 anesthesiologists or 14 specialties.
Typical savings for reducing tardiness of first case of the day starts at a surgical suite equal the product of four values: i) 1.1 min reduction in staffed OR time per 1 min reduction in tardiness, ii) estimate for reductions in tardiness (min) per OR, iii) number of ORs at the suite with more than 8 h of cases, and iv) sum of the average compensations per regularly scheduled minute for personnel in each OR. If small, the analyst and/or clinician can promptly speak up and refocus group conversation toward other potential interventions. If large, the full return on investment analysis would be performed.
参加手术室（OR）委员会会议的分析师和临床医生无法迅速评估关于减少当日第一台手术开始延迟的建议在经济上是否有益。
使用来自一个拥有六个手术室的门诊手术机构的三年数据。采用麦金托什等人的方法（《麻醉与镇痛》2006年；103:1499 - 516）计算减少当日第一台手术开始延迟所带来的成本降低，该方法仅限于手术时长和周转时间至少为8小时的手术室。然后，将当日第一台手术延迟开始时间每减少一分钟的结果报告出来，以便在会议中快速使用。
在手术时长和周转时间超过8小时的手术室中，当日第一台手术延迟开始时间每减少1.0分钟，总体上会使常规安排的劳动力成本减少1.1±0.1分钟（均值±标准误）。这一结果与之前使用完全不同的（模拟）方法得出的手术室时间减少1.2分钟相近。二次分析证实该机构满足相关假设，从而降低了结果存在偏差的可能性。例如，麻醉医生和专业导致的延迟方差比例分别仅为1%和3%，85名麻醉医生或14个专业之间的延迟没有显著差异。
减少手术科室当日第一台手术延迟的典型节省等于四个值的乘积：i）延迟时间每减少1分钟，配备人员的手术室时间减少1.1分钟；ii）每个手术室延迟时间减少量（分钟）的估计值；iii）手术时长超过8小时的手术室数量；iv）每个手术室中按常规安排的每分钟人员平均薪酬总和。如果节省金额较小，分析师和/或临床医生可以立即提出并将小组讨论重点转向其他潜在干预措施。如果节省金额较大，则会进行全面的投资回报分析。
