Dexter Franklin, Marcon Eric, Aker John, Epstein Richard H
Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA 52242, USA.
Anesth Analg. 2009 Sep;109(3):900-5. doi: 10.1213/ane.0b013e3181b08855.
More personnel are needed to turn over operating rooms (ORs) promptly when there are more simultaneous turnovers. Anesthesia and/or OR information management system data can be analyzed statistically to quantify simultaneous turnovers to evaluate whether to add an additional turnover team.
Data collected for each case at a six OR facility were room, date of surgery, time of patient entry into the OR, and time of patient exit from the OR. The number of simultaneous turnovers was calculated for each 1 min of 122 4-wk periods. Our end point was the reduction in the daily minutes of simultaneous turnovers exceeding the number of teams caused by the addition of a team.
Increasing from two turnover teams to three teams reduced the mean daily minutes of simultaneous turnovers exceeding the numbers of teams by 19 min. The ratio of 19 min to 8 h valued the time of extra personnel as 4.0% of the time of OR staff, surgeons, and anesthesia providers. Validity was suggested by other methods of analyses also suggesting staffing for three simultaneous turnovers. Discrete-event simulation showed that the reduction in daily minutes of turnover times from the addition of a team would likely match or exceed the reduction in the daily minutes of simultaneous turnovers exceeding the numbers of teams. Confidence intervals for daily minutes of turnover times achieved by increasing from two to three teams were calculated using successive 4-wk periods. The distribution was sufficiently close to normal that accurate confidence intervals could be calculated using Student's t distribution (Lilliefors' test P = 0.58). Analysis generally should use 13 4-wk periods as increasing the number of periods from 6 to 13 significantly reduced the coefficient of variation of the averages but not increasing the number of periods from 6 to 9 or from 9 to 13.
The number of simultaneous turnovers can be calculated for each 1 min over 1 yr. The reduction in the daily minutes of simultaneous turnovers exceeding the number of teams achieved by the addition of a turnover team can be averaged over the year's 13 4-wk periods to provide insight as to the value (or not) of adding an additional team.
当同时进行的手术室周转次数增多时，需要更多人员来迅速完成手术室周转。麻醉和/或手术室信息管理系统的数据可进行统计分析，以量化同时进行的周转次数，从而评估是否需要增加一个周转团队。
在一个拥有6间手术室的机构中，为每个病例收集的数据包括手术室房间号、手术日期、患者进入手术室的时间以及患者离开手术室的时间。在122个4周时间段内，每1分钟计算一次同时进行的周转次数。我们的终点是通过增加一个团队，使每日同时进行的周转次数超过团队数量的分钟数减少。
将周转团队从两个增加到三个，使每日同时进行的周转次数超过团队数量的平均分钟数减少了19分钟。19分钟与8小时的比例表明，额外人员的时间占手术室工作人员、外科医生和麻醉人员时间的4.0%。其他分析方法也表明应配备人员以应对三个同时进行的周转，这提示了该结果的有效性。离散事件模拟显示，增加一个团队导致的周转时间每日分钟数的减少可能与或超过同时进行的周转次数超过团队数量的每日分钟数的减少。使用连续的4周时间段计算从两个团队增加到三个团队后周转时间每日分钟数的置信区间。分布足够接近正态分布，以至于可以使用学生t分布计算准确的置信区间（利利福斯检验P = 0.58）。一般分析应使用13个4周时间段，因为将时间段数量从6个增加到13个可显著降低平均值的变异系数，但从6个增加到9个或从9个增加到13个则不会。
可以计算出一年中每1分钟同时进行的周转次数。通过增加一个周转团队实现的每日同时进行的周转次数超过团队数量的分钟数的减少，可以在一年的13个4周时间段内进行平均，以洞察增加一个额外团队的价值（或无价值）。
