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ECONOMICS, EDUCATION, AND POLICY

The Impact of Service-Specific Staffing, Case Scheduling, Turnovers, and First-Case Starts on Anesthesia Group and Operating Room Productivity: A Tutorial Using Data from an Australian Hospital

Catherine McIntosh, MBBS, FANZCA^*, Franklin Dexter, MD, PhD, and Richard H. Epstein, MD

From the *Department of Anaesthesia, John Hunter Hospital, Hunter New England Area Health Service, Newcastle, New South Wales, Australia; Department of Anesthesia, Division of Management Consulting, and Department of Health Management and Policy, University of Iowa, Iowa City, Iowa; and Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania.

Address correspondence and reprint requests to Franklin Dexter, MD, PhD, Department of Anesthesia 6-JCP, University of Iowa, Iowa City, IA 52242. Address e-mail to franklin-dexter{at}uiowa.edu.

Abstract

BACKGROUND: In this tutorial, we consider the impact of operating room (OR) management on anesthesia group and OR labor productivity and costs. Most of the tutorial focuses on the steps required for each facility to refine its OR allocations using its own data collected during patient care.

METHODS: Data from a hospital in Australia are used throughout to illustrate the methods. OR allocation is a two-stage process. During the initial tactical stage of allocating OR time, OR capacity ("block time") is adjusted. For operational decision-making on a shorter-term basis, the existing workload can be considered fixed. Staffing is matched to that workload based on maximizing the efficiency of use of OR time.

RESULTS: Scheduling cases and making decisions on the day of surgery to increase OR efficiency are worthwhile interventions to increase anesthesia group productivity. However, by far, the most important step is the appropriate refinement of OR allocations (i.e., planning service-specific staffing) 2–3 mo before the day of surgery.

CONCLUSIONS: Reducing surgical and/or turnover times and delays in first-case-of-the-day starts generally provides small reductions in OR labor costs. Results vary widely because they are highly sensitive both to the OR allocations (i.e., staffing) and to the appropriateness of those OR allocations.

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