Department of Anesthesiology, SUNY Upstate, Syracuse, NewYork, USA.
Anesth Analg. 2010 Mar 1;110(3):879-87. doi: 10.1213/ANE.0b013e3181ce6bbc.
Research in predictive variability of operating room (OR) times has been performed using data from multidisciplinary, tertiary hospitals with mostly adult patients. In this article, we discuss case-duration prediction for children receiving general anesthesia for endoscopy. We critique which of the several types of OR management decisions dependent on accuracy of prediction are relevant to series (lists) of brief pediatric anesthetics.
OR information system data were obtained for all children (aged 18 years and younger) undergoing a gastroenterology procedure with an anesthesiologist over 21 months. Summaries of data were used for a qualitative, systematic review of prior studies to learn which apply to brief pediatric cases. Patient arrival times were changed to be based on the statistical method relating actual and scheduled start times (Wachtel and Dexter, Anesth Analg 2007;105:127-40).
Even perfect case-duration prediction would not affect whether a brief case was performed on a certain date and/or in a certain OR. There was no evidence of usefulness in calculating the probability that one case would last longer than another or in resequencing cases to influence postanesthesia care unit staffing or patient waiting from scheduled start times. The only decision for which the accuracy of case-duration prediction mattered was for the shortest time that preceding cases in the OR may take. Knowledge of the preceding procedures in the OR was not useful for that purpose because there were hundreds of combinations of preceding procedures and some cases cancelled. Instead, patient ready times were chosen based on 5% lower prediction bounds for ratios of actual to scheduled OR times. The approach was useful based on a 30% reduction in patient waiting times from scheduled start times with corresponding expected reductions in average and peak numbers of patients in the holding area.
For brief pediatric OR anesthetics, predictive variability of case durations matters principally to the extent that it affects appropriate patient ready times. Such times should not be chosen by having patients start fasting, arrive, and be ready fixed numbers of hours before their scheduled start times.
针对手术室（OR）时间的可预测性变化的研究是使用来自多学科、三级医院的成人患者数据进行的。在本文中，我们讨论了接受全身麻醉进行内镜检查的儿童的手术持续时间预测。我们评价了依赖于预测准确性的几种手术室管理决策类型中，哪些与简短的儿科麻醉系列（列表）相关。
在 21 个月期间，我们从所有（年龄在 18 岁及以下）接受麻醉医师进行胃肠病学程序的儿童中获取了手术室信息系统数据。使用数据摘要对先前的研究进行了定性、系统的回顾，以了解哪些研究适用于简短的儿科病例。患者到达时间基于实际和计划开始时间的统计方法进行了更改（Wachtel 和 Dexter，Anesth Analg 2007；105：127-40）。
即使手术持续时间的预测是完美的，也不会影响简短病例是否在特定日期和/或特定手术室进行。没有证据表明计算一个病例比另一个病例持续时间更长的概率或重新排序病例以影响麻醉后护理单元人员配备或从计划开始时间等待患者有用。手术持续时间预测准确性唯一重要的决策是手术室中前面病例可能需要的最短时间。手术室中前面手术的知识对于该目的并不有用，因为有数百种前面手术的组合，并且有些病例取消了。相反，基于实际与计划手术室时间的比例的预测下限选择 5%，选择患者准备时间。该方法基于从计划开始时间减少 30%的患者等待时间，并相应地减少等候区的患者数量的平均值和峰值，因此是有用的。
对于简短的儿科 OR 麻醉，手术持续时间的可预测性变化主要影响适当的患者准备时间。不应该通过让患者禁食、到达并在计划开始时间前固定的小时数做好准备来选择这些时间。
