Pandit Jaideep J, Dexter Franklin
Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, United Kingdom.
Anesth Analg. 2009 Jun;108(6):1910-5. doi: 10.1213/ane.0b013e31819fe7a4.
At multiple facilities including some in the United Kingdom's National Health Service, the following are features of many surgical-anesthetic teams: i) there is sufficient workload for each operating room (OR) list to almost always be fully scheduled; ii) the workdays are organized such that a single surgeon is assigned to each block of time (usually 8 h); iii) one team is assigned per block; and iv) hardly ever would a team "split" to do cases in more than one OR simultaneously.
We used Monte-Carlo simulation using normal and Weibull distributions to estimate the times to complete lists of cases scheduled into such 8 h sessions. For each combination of mean and standard deviation, inefficiencies of use of OR time were determined for 10 h versus 8 h of staffing.
When the mean actual hours of OR time used averages < or = 8 h 25 min, 8 h of staffing has higher OR efficiency than 10 h for all combinations of standard deviation and relative cost of over-run to under-run. When mean > or = 8 h 50 min, 10 h staffing has higher OR efficiency. For 8 h 25 min < mean < 8 h 50 min, the economic break-even point depends on conditions. For example, break-even is: (a) 8 h 27 min for Weibull, standard deviation of 60 min and relative cost of over-run to under-run of 2.0 versus (b) 8 h 48 min for normal, standard deviation of 0 min and relative cost ratio of 1.50. Although the simplest decision rule would be to staff for 8 h if the mean workload is < or = 8 h 40 min and to staff for 10 h otherwise, performance was poor. For example, for the Weibull distribution with mean 8 h 40 min, standard deviation 60 min, and relative cost ratio of 2.00, the inefficiency of use of OR time would be 34% larger if staffing were planned for 8 h instead of 10 h.
For surgical teams with 8 h sessions, use the following decision rule for anesthesiology and OR nurse staffing. If actual hours of OR time used averages < or = 8 h 25 min, plan 8 h staffing. If average > or = 8 h 50 min, plan 10 h staffing. For averages in between, perform the full analysis of McIntosh et al. (Anesth Analg 2006;103:1499-516).
在包括英国国民医疗服务体系中的一些机构在内的多个医疗机构中，许多外科麻醉团队具有以下特点：i）每个手术室（OR）的工作量充足，以至于几乎每个手术安排表都能排满；ii）工作日的安排方式是，每个时间段（通常为8小时）分配一名外科医生；iii）每个时间段分配一个团队；iv）团队几乎不会“拆分”去同时在多个手术室进行手术。
我们使用基于正态分布和威布尔分布的蒙特卡洛模拟来估计完成安排在8小时时间段内的手术清单所需的时间。对于均值和标准差的每种组合，确定了10小时与8小时人员配置情况下手术室时间使用的低效率情况。
当手术室实际使用时间的平均时长≤8小时25分钟时，对于标准差和超时与未超时的相对成本的所有组合，8小时人员配置的手术室效率高于10小时。当均值≥8小时50分钟时，10小时人员配置的手术室效率更高。对于8小时25分钟＜均值＜8小时50分钟的情况，经济平衡点取决于具体条件。例如，平衡点为：（a）威布尔分布时为8小时27分钟，标准差为60分钟，超时与未超时的相对成本为2.0；（b）正态分布时为8小时48分钟，标准差为0分钟，相对成本比为1.50。虽然最简单的决策规则是，如果平均工作量≤8小时40分钟，则安排8小时人员配置，否则安排10小时人员配置，但实际效果不佳。例如，对于均值为8小时40分钟、标准差为60分钟、相对成本比为2.00的威布尔分布，如果安排8小时人员配置而不是10小时人员配置，手术室时间使用的低效率将高出34%。
对于8小时工作时段的外科团队，在麻醉和手术室护士人员配置方面采用以下决策规则。如果手术室实际使用时间的平均时长≤8小时25分钟，则安排8小时人员配置。如果平均时长≥8小时50分钟，则安排10小时人员配置。对于介于两者之间的平均时长，进行麦金托什等人的全面分析（《麻醉与镇痛》2006年；103：1499 - 516）。
