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.
BACKGROUND: 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...
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Format: | Journal article |
Language: | English |
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2009
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author | Pandit, J Dexter, F |
author_facet | Pandit, J Dexter, F |
author_sort | Pandit, J |
collection | OXFORD |
description | BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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). |
first_indexed | 2024-03-07T06:12:36Z |
format | Journal article |
id | oxford-uuid:f00b569f-d1b4-4584-b640-ced03d1b4243 |
institution | University of Oxford |
language | English |
last_indexed | 2024-03-07T06:12:36Z |
publishDate | 2009 |
record_format | dspace |
spelling | oxford-uuid:f00b569f-d1b4-4584-b640-ced03d1b42432022-03-27T11:44:41ZLack 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.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:f00b569f-d1b4-4584-b640-ced03d1b4243EnglishSymplectic Elements at Oxford2009Pandit, JDexter, F BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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). |
spellingShingle | Pandit, J Dexter, F 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. |
title | 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. |
title_full | 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. |
title_fullStr | 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. |
title_full_unstemmed | 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. |
title_short | 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. |
title_sort | 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 |
work_keys_str_mv | AT panditj lackofsensitivityofstaffingfor8hoursessionstostandarddeviationindailyactualhoursofoperatingroomtimeusedforsurgeonswithlongqueues AT dexterf lackofsensitivityofstaffingfor8hoursessionstostandarddeviationindailyactualhoursofoperatingroomtimeusedforsurgeonswithlongqueues |