Abstract
BackgroundResident competence in peri-operative care is a reflection on education and cost-efficiency. Inspecting pre-existing operating room metrics for performance outliers may be a potential solution for assessing competence. Statistical correlation of problematic benchmarks may reveal future opportunities for educational intervention.MethodsCase-log database review yielded 3071 surgical cases involving residents over the course of 5 years. Surgery anticipated and actual start times were evaluated for delays and residents were assessed using the days of resident training performed at the time of each corresponding case. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status classification (ASA PS), and in-patient versus day surgery status. Mixed-effect, multi-variable, linear regression determined independent determinants of delay time.ResultsThe analysis identified day of the week (F = 25.65, P < 0.0001), days of training (F = 8.39, P = 0.0038), attending surgeon (F = 2.67, P < 0.0001), and anesthesiology resident (F = 1.67, P = 0.0012) as independent predictors of delay time for first-start cases, with an overall regression model F = 3.09, r2 = 0.186, and P < 0.0001.ConclusionsThe day of the week and attending surgeon demonstrated significant impact of case delay compared to resident days trained. If a learning curve for first-case start punctuality exists for anesthesiology residents, it is subtle and irrelevant to operating room efficiency. The regression model accounted for only 19% of the variability in the outcome of delay time, indicating a multitude of additional unidentified factors contributing to operating room efficiency.
Highlights
Resident competence in peri-operative care is a reflection on education and cost-efficiency
Information extracted from the database consisted of date, day of week, anesthesiology resident name, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status classification (ASA Physical Status (PS)), in-patient versus day surgery status, and time the patient entered the operating room
The analysis identified day of the week (F = 25.65, P < 0.0001), days of training (F = 8.39, P = 0.0038), attending surgeon (F = 2.67, P < 0.0001), and anesthesiology resident (F = 1.67, P = 0.0012) as independent predictors of delay time for firststart cases, with an overall regression model F = 3.09, r2 = 0.186, and P < 0.0001
Summary
Resident competence in peri-operative care is a reflection on education and cost-efficiency. Inspecting pre-existing operating room metrics for performance outliers may be a potential solution for assessing competence. The importance of efficiency in health care becomes most evident in the operating room. Punctuality and minimizing delays play key roles in efficient because time is the most costly operating room resource. Cost estimates range from $20 per minute when excluding personnel to $30 to $80 per minute when including physician and nursing staff [1]. An efficient operating room starts the day on time. Delays in the first case start time could be a measure of resident competency in peri-operative care, and of a teaching hospital’s efficiency. Preoperative delays due to resident training level affect surgeons and other perioperative staff
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