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Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA
To the Editor:
Dr. Udelsman argues persuasively that surgeons, anesthesiologists, and nurses must work together (1). However, better decision making will occur through scientific investigation, such as our study of turnover time (2). Focusing on turnover time to improve OR operations may seem intuitively reasonable. However, scientific investigation has shown that allocating OR time and scheduling cases based on minimizing the inefficiency of use of OR time (3) is a more effective way to reduce staffing costs than is reducing turnover times (3–6).
We think that Dr. Udelsman’s methodological critiques (1) were incorrect. First, our methodology focused on staffing costs as the endpoint (2), not "resource utilization" or "personnel satisfaction." The word "utilization" only appeared once, in a vignette in the Discussion reviewing previous work (2,4). Second, as stated in the first paragraph of the Methods, our methodology excluded holidays and weekends, not "slow days" (1–2).
On the issue of the cost ratio, results are insensitive to the choice. For example, even using a ratio of 4 at Hospital A gives staffing cost reductions within 0.1% of those in Table 2 (in our article) with a ratio of 1.75 (2). When a larger ratio is used, the cost reductions from reducing turnover times are not larger, because more OR time is allocated to complete the cases during the less expensive allocated hours (7).
Footnotes
Dr. Udelsman does not wish to respond.
References
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