Abstract
BackgroundOperating room (OR) metrics are frequently cited when optimizing cost efficacy and quality of care (Weiss et al, Characteristics of operating room procedures in U.S. hospitals, 2011: Statistical brief #170, 2013; Macario A, Anesthesiology 105:237-240, 2006; Childers et al, JAMA Surg 153:e176233, 2018). Little has been reported to evaluate how anesthesia trainees change anesthesia-related efficiencies in the OR. Statistical correlation may demonstrate awareness and implementation of efficient systems-based practice.MethodsUtilizing computerized OR information systems, specific data regarding anesthesia controlled turnover times were collected (546 data points) over the course of 4 months. The type of surgery performed, patient’s American Society of Anesthesiologists (ASA) physical status and OR turnover times were compared for clinical anesthesia (CA) trainee levels CA1, CA2, CA3 and CRNAs. Standard descriptive statistics were computed. Analysis of variance (ANOVA) was performed to compare the average turnover time.ResultsAverage OR turnover time was 31 min ranging from 8 to 60 min. There was a significant difference between the OR turnover time of CA-1 (32 min) compared to CA-3 (29 min) (p = 0.017) and CA-1 compared to CRNA (30 min) (p = 0.016). OR turnover time was significantly shorter in CA-3 and CRNA. The analysis showed no differences between OR turnover time of ASA categories.ConclusionsThese findings posit that trainees improve efficiency over time, but that education may for a time come at the expense of productivity. This trend may demonstrate a more profound understanding and mastery of a learner progressing in the graduate medical education system. This interplay plays a key role in clinical and academic shared success.
Highlights
Operating room (OR) metrics are frequently cited when optimizing cost efficacy and quality of care (Weiss et al, Characteristics of operating room procedures in U.S hospitals, 2011: Statistical brief #170, 2013; Macario A, Anesthesiology 105:237-240, 2006; Childers et al, JAMA Surg 153:e176233, 2018)
OR turnover time was significantly shorter in clinical anesthesia (CA)-3 and certified registered nurse anesthetists (CRNA)
A post-hoc analysis showed significant difference between the OR turnover time of CA-1 compared to CA-3 with significant p value of 0.017 and CA-1 compared to CRNA with significant p value of 0.016. 95% confidence interval of mean difference was 0.54–5.44 and 0.48–4.67 respectively (Table 3)
Summary
Operating room (OR) metrics are frequently cited when optimizing cost efficacy and quality of care (Weiss et al, Characteristics of operating room procedures in U.S hospitals, 2011: Statistical brief #170, 2013; Macario A, Anesthesiology 105:237-240, 2006; Childers et al, JAMA Surg 153:e176233, 2018). Operating rooms (ORs) are one of the most resource-consuming areas of a hospital to provide surgical care. Teaching cases are associated with an increased anesthesia induction time by a mean of 4.5 min (standard deviation 3.2 min) [5]. The introduction of new anesthesia residents causes a statistically significant effect on induction, emergence, and turnover times [6]. Other data suggests that decreases in anesthesia controlled time doesn’t save enough time to increase scheduled surgical cases [7]
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