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ECONOMICS, EDUCATION, AND POLICY

Typical Savings from Each Minute Reduction in Tardy First Case of the Day Starts

Franklin Dexter, MD, PhD^*, and Richard H. Epstein, MD

From the *Departments of Anesthesia and Health Management and Policy, University of Iowa, Iowa; and Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania.

Address correspondence and reprint requests to Franklin Dexter, MD, PhD, Department of Anesthesia, University of Iowa, Iowa City, IA 52242. Address e-mail to Franklin-Dexter{at}UIowa.edu or web site www.FranklinDexter.net.

Abstract

BACKGROUND: Analysts and clinicians sitting in operating room (OR) committee meetings cannot evaluate rapidly whether a suggested idea to reduce delays in first case of the day starts can be beneficial economically.

METHODS: Three years of data were used from a six OR outpatient surgery facility. The cost reduction from reducing the tardiness of start of first cases of the day was calculated using the method of McIntosh et al. (Anesth Analg 2006;103:1499–516), limited to ORs with at least 8 h of cases and turnovers. Results were then reported per minute reduction in tardy first case of the day starts as an approximation for rapid use in meetings.

RESULTS: Each 1.0 min reduction in the tardy starts of first cases of the day in ORs with more than 8 h of cases and turnovers resulted overall in 1.1 ± 0.1 min reduction in regularly scheduled labor costs (mean ± se). This result was close to the 1.2 min obtained using an entirely different (simulation) method performed previously for OR time reductions. Secondary analyses confirmed that assumptions were satisfied at the facility, thereby reducing the chance that results are biased. For example, the proportions of the variance in tardiness attributable to anesthesiologists and specialties were only 1% and 3%, respectively, and there were no significant differences in tardiness among the 85 anesthesiologists or 14 specialties.

CONCLUSIONS: Typical savings for reducing tardiness of first case of the day starts at a surgical suite equal the product of four values: i) 1.1 min reduction in staffed OR time per 1 min reduction in tardiness, ii) estimate for reductions in tardiness (min) per OR, iii) number of ORs at the suite with more than 8 h of cases, and iv) sum of the average compensations per regularly scheduled minute for personnel in each OR. If small, the analyst and/or clinician can promptly speak up and refocus group conversation toward other potential interventions. If large, the full return on investment analysis would be performed.