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ECONOMICS, EDUCATION, AND POLICY

Lack of Sensitivity of Staffing for 8-Hour Sessions to Standard Deviation in Daily Actual Hours of Operating Room Time Used for Surgeons with Long Queues

Jaideep J. Pandit, MA, BM, DPhil, FRCA^*, and Franklin Dexter, MD, PhD

From the *Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, United Kingdom; and Division of Management Consulting, Departments of Anesthesia and Health Management and Policy, University of Iowa, Iowa City, Iowa.

Address correspondence and reprint requests to Franklin Dexter, MD, PhD, Division of Management Consulting, 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: At multiple facilities including some in the United Kingdom’s National Health Service, the following are features of many surgical-anesthetic teams: i) there is sufficient workload for each operating room (OR) list to almost always be fully scheduled; ii) the workdays are organized such that a single surgeon is assigned to each block of time (usually 8 h); iii) one team is assigned per block; and iv) hardly ever would a team "split" to do cases in more than one OR simultaneously.

METHODS: We used Monte-Carlo simulation using normal and Weibull distributions to estimate the times to complete lists of cases scheduled into such 8 h sessions. For each combination of mean and standard deviation, inefficiencies of use of OR time were determined for 10 h versus 8 h of staffing.

RESULTS: When the mean actual hours of OR time used averages 8 h 25 min, 8 h of staffing has higher OR efficiency than 10 h for all combinations of standard deviation and relative cost of over-run to under-run. When mean 8 h 50 min, 10 h staffing has higher OR efficiency. For 8 h 25 min < mean <8 h 50 min, the economic break-even point depends on conditions. For example, break-even is: (a) 8 h 27 min for Weibull, standard deviation of 60 min and relative cost of over-run to under-run of 2.0 versus (b) 8 h 48 min for normal, standard deviation of 0 min and relative cost ratio of 1.50. Although the simplest decision rule would be to staff for 8 h if the mean workload is 8 h 40 min and to staff for 10 h otherwise, performance was poor. For example, for the Weibull distribution with mean 8 h 40 min, standard deviation 60 min, and relative cost ratio of 2.00, the inefficiency of use of OR time would be 34% larger if staffing were planned for 8 h instead of 10 h.

CONCLUSIONS: For surgical teams with 8 h sessions, use the following decision rule for anesthesiology and OR nurse staffing. If actual hours of OR time used averages 8 h 25 min, plan 8 h staffing. If average 8 h 50 min, plan 10 h staffing. For averages in between, perform the full analysis of McIntosh et al. (Anesth Analg 2006;103:1499–516).