Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, United States.
University of Iowa Health Care, Iowa City, IA 52242, United States.
J Clin Anesth. 2017 Nov;42:88-92. doi: 10.1016/j.jclinane.2017.08.016. Epub 2017 Aug 29.
Percentage utilization of operating room (OR) time is not an appropriate endpoint for planning additional OR time for surgeons with high caseloads, and cannot be measured accurately for surgeons with low caseloads. Nonetheless, many OR directors claim that their hospitals make decisions based on individual surgeons' OR utilizations. This incongruity could be explained by the OR managers considering the earlier mathematical studies, performed using data from a few large teaching hospitals, as irrelevant to their hospitals. The important mathematical parameter for the prior observations is the percentage of surgeon lists of elective cases that include 1 or 2 cases; "list" meaning a combination of surgeon, hospital, and date. We measure the incidence among many hospitals.
Observational cohort study.
117 hospitals in Iowa from July 2013 through September 2015.
Surgeons with same identifier among hospitals.
Surgeon lists of cases including at least one outpatient surgical case, so that Relative Value Units (RVU's) could be measured.
Averaging among hospitals in Iowa, more than half of the surgeons' lists included 1 or 2 cases (77%; P<0.00001 vs. 50%). Approximately half had 1 case (54%; P=0.0012 vs. 50%). These percentages exceeded 50% even though nearly all the surgeons operated at just 1 hospital on days with at least 1 case (97.74%; P<0.00001 vs. 50%). The cases were not of long durations; among the 82,928 lists with 1 case, the median was 6 intraoperative RVUs (e.g., adult inguinal herniorrhaphy).
Accurate confidence intervals for raw or adjusted utilizations are so wide for individual surgeons that decisions based on utilization are equivalent to decisions based on random error. The implication of the current study is generalizability of that finding from the largest teaching hospital in the state to the other hospitals in the state.
手术室（OR）时间的利用率对于高工作量的外科医生来说不是规划额外 OR 时间的适当终点，对于工作量低的外科医生来说也不能准确衡量。尽管如此，许多手术室主任声称他们的医院是根据个别外科医生的手术室利用率做出决策的。这种不一致性可以解释为手术室管理人员认为之前的数学研究使用了来自少数大型教学医院的数据，与他们的医院无关。先前观察的重要数学参数是包括 1 例或 2 例手术的择期手术列表中外科医生的百分比；“列表”是指外科医生、医院和日期的组合。我们在许多医院进行了测量。
观察性队列研究。
2013 年 7 月至 2015 年 9 月期间爱荷华州的 117 家医院。
医院间具有相同标识符的外科医生。
包括至少 1 例门诊手术病例的外科医生手术列表，以便测量相对价值单位（RVU）。
爱荷华州各医院的平均值显示，超过一半的外科医生的列表中包括 1 例或 2 例病例（77%；P<0.00001 比 50%）。约有一半（54%；P=0.0012 比 50%）有 1 例病例。即使几乎所有外科医生在至少有 1 例手术的日子都只在 1 家医院工作，这些百分比也超过了 50%（97.74%；P<0.00001 比 50%）。这些病例的持续时间并不长；在有 1 例病例的 82928 个列表中，中位数为 6 个术中 RVU（例如成人腹股沟疝修补术）。
个别外科医生的原始或调整利用率的置信区间非常宽，因此基于利用率的决策等同于基于随机误差的决策。本研究的意义在于从州内最大的教学医院推广到州内的其他医院。
