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*Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City;
Department of Anesthesiology, University of Texas Medical Branch, Galveston;
Department of Anesthesiology, Jefferson Medical College, Philadelphia; 
Medical Data Applications, Ltd., Jenkintown, Pennsylvania;
||Department of Anesthesiology and Pain Medicine, University of Texas Southwestern Medical Center, Dallas; and
¶Department of Anesthesiology, Perioperative Medicine, and Pain Management and School of Business, University of Miami, Florida
Address correspondence and reprint requests to Franklin Dexter, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA 52242. Address e-mail to Franklin-Dexter{at}UIowa.edu
Potential benefits to reducing turnover times are both quantitative (e.g., complete more cases and reduce staffing costs) and qualitative (e.g., improve professional satisfaction). Analyses have shown the quantitative arguments to be unsound except for reducing staffing costs. We describe a methodology by which each surgical suite can use its own numbers to calculate its individual potential reduction in staffing costs from reducing its turnover times. Calculations estimate optimal allocated operating room (OR) time (based on maximizing OR efficiency) before and after reducing the maximum and average turnover times. At four academic tertiary hospitals, reductions in average turnover times of 3 to 9 min would result in 0.8% to 1.8% reductions in staffing cost. Reductions in average turnover times of 10 to 19 min would result in 2.5% to 4.0% reductions in staffing costs. These reductions in staffing cost are achieved predominantly by reducing allocated OR time, not by reducing the hours that staff work late. Heads of anesthesiology groups often serve on OR committees that are fixated on turnover times. Rather than having to argue based on scientific studies, this methodology provides the ability to show the specific quantitative effects (small decreases in staffing costs and allocated OR time) of reducing turnover time using a surgical suite’s own data.
IMPLICATIONS: Many anesthesiologists work at hospitals where surgeons and/or operating room (OR) committees focus repeatedly on turnover time reduction. We developed a methodology by which the reductions in staffing cost as a result of turnover time reduction can be calculated for each facility using its own data. Staffing cost reductions are generally very small and would be achieved predominantly by reducing allocated OR time to the surgeons.
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  R. E. Wachtel and F. Dexter Influence of the Operating Room Schedule on Tardiness from Scheduled Start Times Anesth. Analg., June 1, 2009; 108(6): 1889 - 1901. [Abstract] [Full Text] [PDF]
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R. E. Wachtel and F. Dexter Reducing Tardiness from Scheduled Start Times by Making Adjustments to the Operating Room Schedule Anesth. Analg., June 1, 2009; 108(6): 1902 - 1909. [Abstract] [Full Text] [PDF]
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J. J. Pandit and F. Dexter 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 Anesth. Analg., June 1, 2009; 108(6): 1910 - 1915. [Abstract] [Full Text] [PDF]
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D. Masursky, F. Dexter, M. P. Garver, and N. A. Nussmeier Incentive Payments to Academic Anesthesiologists for Late Afternoon Work Did Not Influence Turnover Times Anesth. Analg., May 1, 2009; 108(5): 1622 - 1626. [Abstract] [Full Text] [PDF]
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F. Dexter and R. H. Epstein Typical Savings from Each Minute Reduction in Tardy First Case of the Day Starts Anesth. Analg., April 1, 2009; 108(4): 1262 - 1267. [Abstract] [Full Text] [PDF]
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C. McIntosh, F. Dexter, and R. H. Epstein 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 Anesth. Analg., December 1, 2006; 103(6): 1499 - 1516. [Abstract] [Full Text] [PDF]
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F. Dexter and R. E. Wachtel Economic, Educational, and Policy Perspectives on the Preincision Operating Room Period Anesth. Analg., October 1, 2006; 103(4): 919 - 921. [Full Text] [PDF]
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A. Escobar, E. A. Davis, J. Ehrenwerth, G. A. Watrous, G. S. Fisch, Z. N. Kain, and P. G. Barash Task Analysis of the Preincision Surgical Period: An Independent Observer-Based Study of 1558 Cases Anesth. Analg., October 1, 2006; 103(4): 922 - 927. [Abstract] [Full Text] [PDF]
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H. Saadat, A. Escobar, E. A. Davis, J. Ehrenwerth, G. Watrous, G. S. Fisch, Z. N. Kain, and P. G. Barash Task Analysis of the Preincision Period in a Pediatric Operating Suite: An Independent Observer-Based Study of 656 Cases Anesth. Analg., October 1, 2006; 103(4): 928 - 931. [Abstract] [Full Text] [PDF]
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F. Dexter, J. C. Yue, and A. J. Dow Predicting anesthesia times for diagnostic and interventional radiological procedures. Anesth. Analg., May 1, 2006; 102(5): 1491 - 1500. [Abstract] [Full Text] [PDF]
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 J. C. Cendan and M. Good Interdisciplinary Work Flow Assessment and Redesign Decreases Operating Room Turnover Time and Allows for Additional Caseload Arch Surg, January 1, 2006; 141(1): 65 - 69. [Abstract] [Full Text] [PDF]
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F. Dexter, E. Marcon, R. H. Epstein, and J. Ledolter Validation of Statistical Methods to Compare Cancellation Rates on the Day of Surgery Anesth. Analg., August 1, 2005; 101(2): 465 - 473. [Abstract] [Full Text] [PDF]
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M. Schuster, T. Standl, H. Reissmann, L. Kuntz, and J. S. am Esch Reduction of Anesthesia Process Times After the Introduction of an Internal Transfer Pricing System for Anesthesia Services Anesth. Analg., July 1, 2005; 101(1): 187 - 194. [Abstract] [Full Text] [PDF]
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 A. Macario, F. Dexter, and D. Lubarsky Meta-analysis of trials comparing postoperative recovery after anesthesia with sevoflurane or desflurane Am. J. Health Syst. Pharm., January 1, 2005; 62(1): 63 - 68. [Abstract] [Full Text] [PDF]
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S. Z. Yoon and F. Dexter The Necessity of Guidelines for Any Workday or Four Weeks Systems for Allocating OR Times * Response Anesth. Analg., October 1, 2004; 99(4): 1263 - 1263. [Full Text] [PDF]
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F. Dexter and D. L. Brown Financial Disclosure Anesth. Analg., June 1, 2004; 98(6): 1811 - 1811. [Full Text] [PDF]
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F. Dexter, R. H. Epstein, A. E. Abouleish, C. W. Whitten, and D. A. Lubarsky Impact of Reducing Turnover Times on Staffing Costs Anesth. Analg., March 1, 2004; 98(3): 872 - 872. [Full Text] [PDF]
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R. Udelsman The Operating Room: War Results in Casualties Anesth. Analg., October 1, 2003; 97(4): 936 - 937. [Full Text] [PDF]
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