From the Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania; and Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa.
Anesth Analg. 2013 Oct;117(4):995-1002. doi: 10.1213/ANE.0b013e3182a0d9f6. Epub 2013 Sep 10.
Conceptually, cancelling a case close to the scheduled day of surgery increases variability in operating room (OR) workload (i.e., total hours of scheduled cases plus turnovers), creating managerial problems. However, in our recent study of an OR scheduling office, cancellations (slightly) reduced variability in workload among days. If a relatively low incidence of cancellations does not cause increased variability in workload, this would be a useful finding when focusing strategic OR management initiatives. However, the previous study considered only the effect on the schedule for the day the cancelled case originally was scheduled to be performed, not the future date on which the case was performed.
For 90% of cancelled cases, the patient later underwent the same or a similar procedure at the studied hospital. Thus, the OR schedule at 7:00 am each day over 2 years could be used to study case rescheduling. The primary end point, calculated for each surgeon, was the difference of 2 ratios. The first ratio was the proportion of scheduled workload attributable to previously cancelled cases, among all days for which the surgeon's workload exceeded the surgeon's median workload. The second ratio was that proportion among the other days when the surgeon performed at least 1 case. Means ± SEMs were calculated by random effects analysis, stratified by surgeon.
From 7:00 am the working day before surgery through the day of surgery, 9.7% ± 0.6% of scheduled OR hours and 9.7% ± 0.5% of cases were cancelled. Among cases performed, 9.5% ± 0.5% of the scheduled hours and 9.5% ± 0.5% of the cases were previously cancelled (i.e., rescheduled to a later date and then performed). Surgeons' median workloads on days with at least 1 case were 8.3 ± 0.2 hours. The percentage of scheduled workload attributable to rescheduled cases was slightly less on days when the surgeon had larger than median workloads (-0.7% ± 0.3%, P = 0.022).
Rescheduled cancelled cases did not increase variability in OR workload. This finding is useful combined with our recent finding that cancellation slightly reduces variability in OR workload on the date of cancellation. Cancellations should not be interpreted as a system failure that increases variability in surgical workload. We recommend that anesthesiologists aim to reduce cancellation rates if above benchmarked averages, but otherwise focus on more strategically beneficial initiatives. We recommend also that these results be considered if cancellation rates are used in assessing anesthesiology group performance.
从概念上讲，在接近手术日取消病例会增加手术室（OR）工作量的变异性（即计划手术总时间加上周转时间），从而产生管理问题。然而，在我们最近对 OR 调度办公室的研究中，取消手术（略有）减少了各天之间工作量的变异性。如果相对较低的取消率不会导致工作量的变异性增加，那么当集中进行 OR 管理策略时，这将是一个有用的发现。然而，之前的研究仅考虑了取消病例原定手术日的日程安排的影响，而没有考虑该病例进行手术的未来日期。
对于 90%的取消病例，患者随后在研究医院接受了相同或类似的手术。因此，可以使用 2 年来每天早上 7:00 的 OR 时间表来研究病例重新安排。每位外科医生的主要终点是两个比值的差异。第一个比值是取消手术之前归因于所有手术日的计划工作量的比例，其中外科医生的工作量超过外科医生的中位数工作量。第二个比值是在外科医生进行至少 1 例手术的其他日子中的这一比例。通过随机效应分析，按外科医生分层计算均值±SEM。
从手术前一天早上 7:00 开始，直至手术当天，有 9.7%±0.6%的预定 OR 时间和 9.7%±0.5%的病例被取消。在已进行的病例中，9.5%±0.5%的预定时间和 9.5%±0.5%的病例是先前取消的（即重新安排到较晚的日期并随后进行）。至少进行 1 例手术的日子里，外科医生的中位数工作量为 8.3±0.2 小时。在外科医生工作量大于中位数的日子里，重新安排的病例占计划工作量的比例略小（-0.7%±0.3%，P=0.022）。
重新安排的取消病例并没有增加 OR 工作量的变异性。这一发现与我们最近的发现结合在一起，即取消手术略减少了取消日的 OR 工作量变异性。取消不应被视为增加手术工作量变异性的系统故障。如果取消率高于基准平均值，我们建议麻醉师旨在降低取消率，但除此之外，还应专注于更具战略意义的有益举措。我们还建议，如果取消率用于评估麻醉科团队的绩效，应考虑这些结果。
