Department of Anesthesia, University of Iowa, 200 Hawkins Drive, 6 JCP, Iowa City, IA, 52242, USA.
Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Coral Gables, FL, USA.
J Med Syst. 2018 Nov 12;42(12):259. doi: 10.1007/s10916-018-1114-3.
Statistical methods to calculate the hours into which cases are scheduled, based on minimizing the inefficiency of use of anesthesia and/or operating room (OR) time, assure that anesthesiologists and OR nurses are available on each day to care for patients while infrequently working late. The method assumes that anesthesia staffing is planned based on the workload and not vice-versa. We used the American Society of Anesthesiologists (ASA) meeting to test the assumption across a large population. The observational study cohort was all 3,191,282 major therapeutic procedures performed during 2,517,842 cases at all 121 non-federal hospitals in the State of Iowa, 2007-16. The Fridays to Wednesdays of the annual ASA meetings were compared pairwise by year with those days of the other (mean = 43.0 [SE =0.3]) weeks without a federal holiday. Differences in counts of procedures (P = 0.45, 0.5% [0.7%]) and cases performed (P = 0.93, 0.1% [1.0%]) were not significant. In contrast, compared to non-meeting weeks, during the American College of Surgeons meeting, there were fewer general surgery procedures performed (P = 0.0009, -9.1% [1.9%]), fewer procedures performed of any type (P = 0.022, -2.1% [0.8]), and fewer cases of any type (P = 0.003, -2.5% [0.6%]). Similarly, during the American Academy of Orthopaedic Surgeons meeting, there were fewer joint arthroplasties performed (P < 0.0001, -27.1% [3.1%]), fewer procedures (P = 0.011, -6.3% [2.0%]), and fewer cases (P = 0.018, -5.9% [2.0%]). The results show that, in routine practice, anesthesia staffing and staff scheduling are being chosen to prevent the meeting from affecting patients' and surgeons' access to OR time.
基于最小化麻醉和/或手术室(OR)时间利用效率的原则,统计方法可以计算病例安排的时间,以确保每天都有足够的麻醉师和 OR 护士为患者提供护理,并且很少需要加班。该方法假设麻醉人员配置是根据工作量进行规划的,而不是相反。我们使用美国麻醉医师学会(ASA)会议在大量人群中测试了这一假设。这项观察性研究队列包括 2007 年至 2016 年在爱荷华州 121 家非联邦医院进行的 3191282 例主要治疗性手术,其中包括所有病例。每年 ASA 会议的星期五至星期三与其他(平均 43.0[SE=0.3])周的非联邦假日进行配对比较。手术次数(P=0.45,0.5%[0.7%])和手术次数(P=0.93,0.1%[1.0%])无显著差异。相比之下,与非会议周相比,在美国外科医师学会会议期间,普通外科手术减少(P=0.0009,减少 9.1%[1.9%]),任何类型的手术减少(P=0.022,减少 2.1%[0.8%]),任何类型的手术例数减少(P=0.003,减少 2.5%[0.6%])。同样,在美国矫形外科医师学会会议期间,关节置换术减少(P<0.0001,减少 27.1%[3.1%]),手术减少(P=0.011,减少 6.3%[2.0%]),手术例数减少(P=0.018,减少 5.9%[2.0%])。结果表明,在常规实践中,麻醉人员配置和人员排班的选择是为了防止会议影响患者和外科医生对 OR 时间的使用。