Routman Justin S, Zhang Erik J, Blocker Jonathan D, Paiste Juhan, Tsai Mitchell H
Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA.
J Med Syst. 2025 Jul 9;49(1):96. doi: 10.1007/s10916-025-02229-5.
In high-cost, high-revenue operating room (OR) suites, dashboards displaying key performance indicators are commonplace to optimize efficiency. Given the significant successes attained, further gains may risk compromising safety. In contrast, challenges unique to non-operating room anesthesia (NORA) sites have hindered operational efficiency. Existing productivity evaluation frameworks often fall short in guiding strategic and tactical improvements in NORA delivery. Performance frontiers have proven effective in evaluating OR systems, but their application to NORA remains unexplored. This study applies performance frontiers to assess NORA site efficiency and formulates potential operational strategies.
We evaluated anesthesia billing records at our primary hospital from 1 April 2022 to 30 March 2023. Cases from operating room and NORA locations were included, except for sites with irregular volume or financial arrangements. We included only non-holiday weekdays, defining NORA block time as 7 AM to 5 PM. For each room, we calculated under-utilized (time with no anesthesia billing) and over-utilized minutes (time billed outside of NORA block hours). Data for each location were plotted as rolling 4-week sums, normalized to scheduled NORA block time. Performance frontiers were then developed and plotted.
Over 246 non-holiday weekdays, 42,424 cases had billable minutes during NORA block time, comprising 20,003 (47.2%) NORA cases and 22,421 (52.8%) OR cases. Performance frontiers revealed significant variability, with nonparametric tests confirming statistical significance and non-equivalence.
Performance frontiers reveal substantial efficiency variability across NORA sites, underscoring the need for targeted interventions. Some sites matched OR efficiency levels, while others showed substantial differences, particularly those with high variability and urgency. Efficient sites can leverage performance frontiers to optimize resource allocation, while inefficient locations may benefit from a shared anesthesia resource pool for real-time resource allocation. Performance frontiers provide a novel approach for operational leaders to make more effective strategic decisions.
在高成本、高收益的手术室（OR）套房中，显示关键绩效指标的仪表板司空见惯，以优化效率。鉴于已取得的显著成功，进一步提高效率可能会危及安全。相比之下，非手术室麻醉（NORA）场所特有的挑战阻碍了运营效率。现有的生产率评估框架在指导NORA服务的战略和战术改进方面往往存在不足。绩效前沿已被证明在评估手术室系统方面有效，但其在NORA中的应用仍未得到探索。本研究应用绩效前沿来评估NORA场所的效率，并制定潜在的运营策略。
我们评估了2022年4月1日至2023年3月31日我院的麻醉计费记录。包括手术室和NORA场所的病例，但不包括数量或财务安排不规律的场所。我们只纳入非节假日工作日，将NORA时间段定义为上午7点至下午5点。对于每个房间，我们计算了未充分利用的时间（无麻醉计费的时间）和过度利用的分钟数（在NORA时间段之外计费的时间）。每个场所的数据以滚动4周总和的形式绘制，并根据预定的NORA时间段进行归一化。然后绘制绩效前沿。
在246个非节假日工作日期间，42424例病例在NORA时间段有可计费分钟，其中包括20003例（47.2%）NORA病例和22421例（52.8%）手术室病例。绩效前沿显示出显著的变异性，非参数检验证实了统计学显著性和非等效性。
绩效前沿揭示了NORA场所之间存在显著的效率差异，强调了针对性干预的必要性。一些场所达到了手术室的效率水平，而另一些场所则显示出显著差异，特别是那些变异性和紧迫性较高的场所。高效的场所可以利用绩效前沿来优化资源分配，而效率低下的场所可能受益于共享麻醉资源池进行实时资源分配。绩效前沿为运营领导者做出更有效的战略决策提供了一种新方法。
