Journal article
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
Anesthesia and analgesia, Vol.108(6), pp.1910-1915
06/2009
DOI: 10.1213/ane.0b013e31819fe7a4
PMID: 19448221
Abstract
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. 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. When the mean actual hours of OR time used averages < or = 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 > or = 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 < or = 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. 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 < or = 8 h 25 min, plan 8 h staffing. If average > or = 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).
Details
- Title: Subtitle
- 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
- Creators
- Jaideep J Pandit - Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, United KingdomFranklin Dexter
- Resource Type
- Journal article
- Publication Details
- Anesthesia and analgesia, Vol.108(6), pp.1910-1915
- Publisher
- United States
- DOI
- 10.1213/ane.0b013e31819fe7a4
- PMID
- 19448221
- ISSN
- 0003-2999
- eISSN
- 1526-7598
- Language
- English
- Date published
- 06/2009
- Academic Unit
- Health Management and Policy; Anesthesia
- Record Identifier
- 9983806260502771
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