Anesth Analg 2004;99:1263
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000132716.41601.C8
LETTERS TO THE EDITOR
The Necessity of Guidelines for Any Workday or Four Weeks Systems for Allocating OR Times
Seung Z. Yoon, MD
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
To the Editor:
I read with great interest the report by Dexter et al. (1) regarding changing allocations of operating room (OR) time. The authors recommended the Any Workday or Four Weeks systems for allocating OR times. These two systems aim to maximize OR efficiency rather than allocating OR time based on historical utilization. Recently, as in the United States, we faced financial problems, so we are pressed to perform all cases scheduled by surgeons. In my institutions, allocating OR time is based on historical utilization, as in many other hospitals in Korea. I think that the Any Workday and Four Weeks systems can be helpful.
I think there are many anesthesiologists who allocate OR times with limited economic knowledge and face the same economical pressure as I do. Changing allocations of OR time is fascinating, but for me it was very difficult to understand the article, as I do not have an MBA and have limited economic knowledge. The authors wrote that readers should refer to the references for a description of statistical methods and their rationales. After reading the references, it is still difficult to understand.
I think it is sufficient to discuss the validity of study methodology and demonstrate the efficiency of the Any Workday and Four Weeks systems. The practitioner wants to know how to use the systems in practice, so I propose that Anesthesia & Analgesia publish guidelines for the Any Workday and Four Weeks systems for allocating OR times, or that an expert in this field write a review article to aid practitioners.
Reference
- Dexter F, Macario A. Changing allocations of operating room time from a system based on historical utilization to one where the aim is to schedule as many surgical cases as possible. Anesth Analg 2002; 94: 1272–9.[Abstract/Free Full Text]
Response
Franklin Dexter, MD PhD
Director, Division of Management Consulting, Department of Anesthesia, University of Iowa, IA
In Response:
I agree with Dr. Yoon that many practitioners want to know how to allocate OR time and schedule cases to maximize OR efficiency. There are several existing options.
The Division of Management Consulting of the Department of Anesthesia at the University of IA has an online continuing education program. The URL is <http://www.franklindexter.net/>www.FranklinDexter.net. I currently have four audio lectures with downloadable slides at the site: OR allocation and case scheduling based on OR efficiency, financial assessment for tactical decision-making, afternoon anesthesia staffing to increase productivity and reduce costs, and the economics of anesthetic drugs and supplies. A CD with the lectures can be purchased and shipped worldwide. The Web site also includes multiple recommendations on implementation including a Frequently Asked Questions page.
Since publication of Dexter and Macario in 2002 (1), we published in 2003 articles in Anesthesia & Analgesia that included reviews of the topic. Abouleish et al. (2) explained how to use the principles to estimate the cost to an anesthesia group and/or hospital in OR time not being allocated and cases not being scheduled based on maximizing OR efficiency. Dexter et al. (3) considered the cost impact of reductions in turnover times once OR time has been allocated and cases are being scheduled based on maximizing OR efficiency. The Editor kindly permitted the Discussion in the latter article to serve, essentially, as a review article.
We published a review article in 2003 (4), and have two in press for publication in 2004 (5,6).
Finally, I have three conference proceedings with written text in 2003 and 2004 (7–9).
References
- Dexter F, Macario A. Changing allocation of operating room time from a system based on historical utilization to one where the aim is to schedule as many surgical cases as possible. Anesth Analg 2002; 94: 1272–9.
- Abouleish AE, Dexter F, Epstein RH, et al. Labor costs incurred by anesthesiology groups because of operating rooms not being allocated and cases not being scheduled to maximize operating room efficiency. Anesth Analg 2003; 96: 1109–13.[Abstract/Free Full Text]
- Dexter F, Abouleish AE, Epstein RH, et al. Use of operating room information system data to predict the impact of reducing turnover times on staffing costs. Anesth Analg 2003; 97: 1119–26.[Abstract/Free Full Text]
- Dexter F, Epstein RH. Scheduling of cases in an ambulatory center. Anesthesiol Clin North America 2003; 21: 387–402.[Medline]
- Dexter F, Epstein RH, Ippolito GV. Practical application of research on operating room efficiency and utilization. McLoughlin T, Lake C, Johnson J, eds. New York: Elsevier, Advances in Anesthesia. In press.
- Dexter F, Epstein RD, Traub RD, Xiao Y. Making management decisions on the day of surgery based on operating room efficiency and patient waiting times: review of scientific studies. Anesthesiology. In press.
- Dexter F. Refresher course: Allocating operating room time and scheduling surgical cases to maximize OR efficiency. Presented at the annual meeting of the American Society of Anesthesiologists, October 2003, San Francisco, California.
- Dexter F. Maximizing OR efficiency to reduce anesthesia costs. Presented at the 18th International Winter Anesthesiology Symposium, January 2004, Leuven, Belgium.
- Dexter F. Increasing operating room utilization. Presented at the annual meeting of the World Congress of Anaesthesiology, April 2004, Paris, France.
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