Journal article
Bypass of an anesthesiologist-directed preoperative evaluation clinic results in greater first-case tardiness and turnover times
Journal of Clinical Anesthesia, Vol.41, pp.112-119
09/2017
DOI: 10.1016/j.jclinane.2017.04.009
PMID: 28438362
Abstract
We evaluated 4 hypotheses related to bypass of an anesthesiologist-directed preoperative evaluation clinics (APEC): 1) first-case tardiness and turnover times increased; 2) turnover times increased more than first-case tardiness; and higher American Society of Anesthesiologists Physical Status (ASA PS) resulted in both an ordered increase among ASA PS and within ASA PS in 3) first-case tardiness; and 4) turnover times. Retrospective observational study using electronic health records. One large, teaching hospital. An average of 14,310 patients per year undergoing elective surgery in the hospital's main opera rating rooms who were not inpatients preoperatively between 2006 and 2016. None. Average increases in first-case tardiness and turnover times between patients seen or not seen preoperatively in the APEC. APEC bypass increased first-case tardiness 2.58 min per case (CI 1.55–3.61; P<0.0001) and turnover times by 7.49 min (CI 6.79–8.19; P<0.0001). The increase in mean turnover time was greater than mean first-case tardiness (difference=4.91 min; CI 3.76–6.06; P<0.0001). Had all patients bypassed the APEC, the increase in total minutes OR− 1 workday− 1 for turnover times would have been larger than the increase in first-case tardiness (difference=5.71, CI 3.17–4.72; P<0.0001). There was an ordered increase with APEC bypass for both first-case tardiness and turnover times with increasing ASA PS (P<0.0001). Within ASA PS, first-case tardiness (all P-values<0.003) and turnover times (all P-values<0.0001) also increased with APEC bypass. All 4 hypotheses were accepted. Overall and with control for ASA PS, APEC bypass increases first-case tardiness and turnover times. A strategy of selective bypass of ASA PS 1–2 patients would not be effective economically because of substantial delays from ASA PS 2 patients.
Details
- Title: Subtitle
- Bypass of an anesthesiologist-directed preoperative evaluation clinic results in greater first-case tardiness and turnover times
- Creators
- Richard H Epstein - Department of Anesthesiology, Pain Management and Perioperative Medicine, University of Miami, Miller School of Medicine, 1400, NW, 12th Avenue, Suite 3075, Miami, Florida 33136, United StatesFranklin Dexter - Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242, United StatesEric S Schwenk - Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, United StatesThomas A Witkowski - Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, United States
- Resource Type
- Journal article
- Publication Details
- Journal of Clinical Anesthesia, Vol.41, pp.112-119
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jclinane.2017.04.009
- PMID
- 28438362
- ISSN
- 0952-8180
- eISSN
- 1873-4529
- Language
- English
- Date published
- 09/2017
- Academic Unit
- Health Management and Policy; Anesthesia
- Record Identifier
- 9983806262902771
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