Abstract
A nursing strike represents an operational disruption from normal perioperative services. The impact a nursing strike has on a perioperative system has not been well studied. The purpose of this study was to evaluate the realized and unrealized financial and operational impacts a nursing strike has on perioperative services. This was a retrospective analysis conducted at an academic, rural medical center during a nursing strike. During the nursing strike, the hospital implemented measures to maintain patient safety and continue normal operations. Several operating room (OR) management and clinical productivity metrics were used to evaluate the realized and unrealized financial and operational impacts. First Case Start Delay times increased (+69%), Scheduling Error decreased (-42%), Clinical Productivity decreased (-6%), Total ASA units decreased (-44%), Productivity per Attending decreased (-55%), estimated missed revenue of $864,118, and missed expected profit of $432,059. The changes in overall OR workflow resulted in additional expenses, loss of individual productivity and concomitant lost revenue from cancelled cases. Some operational metrics improved. Tactical planning to maintain clinical operations during a strike must involve clinical directors and anesthesiology administrators. The primary directive should balance patient safety against long-term implications and account for unrealized costs.
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