Statistical power analysis to estimate how many months of data are required to identify PACU staffing to minimize delays in admission from ORs.

When each nurse in the Phase I setting is caring for the maximum number of patients allowed by hospital staffing standards (typically 2 per ASPAN standards), patients may have to be held in the OR until a PACU nurse becomes available. Previously, the authors described a statistical method to determine the process of scheduling existing nurses without increasing staffing hours (Dexter et al. Anesth Analg.

How to schedule elective surgical cases into specific operating rooms to maximize the efficiency of use of operating room time.

Unlabelled: We considered elective case scheduling at hospitals and surgical centers at which surgeons and patients choose the day of surgery, cases are not turned away, and anesthesia and nursing staffing are adjusted to maximize the efficiency of use of operating room (OR) time. We investigated scheduling a new case into an OR by using two patient-scheduling rules: Earliest Start Time or Latest Start Time. By using several scenarios, we showed that the use of Earliest Start Time is rational economically at such facilities.

Use of linear programming to estimate impact of changes in a hospital's operating room time allocation on perioperative variable costs.

Background: Administrators at hospitals with a fixed annual budget may want to focus surgical services on priority areas to ensure its community receives the best health services possible. However, many hospitals lack the detailed managerial accounting data needed to ensure that such a change does not increase operating costs. The authors used a detailed hospital cost database to investigate by how much a change in allocations of operating room (OR) time among surgeons can increase perioperative variable costs.

Statistical power analysis to estimate how many months of data are required to identify operating room staffing solutions to reduce labor costs and increase productivity.

Unlabelled: We performed a statistical power analysis to determine how many historical data are needed for optimal operating room (OR) management decision making. The work applies to hospitals that provide service for all of its surgeons' elective cases on whatever workday the surgeons and patients choose. The hospital and anesthesia group adjust OR staffing and patient scheduling to care for the patients while minimizing OR staffing costs and maximizing labor productivity.

What are the most important risk factors for a patient's developing intraoperative hypothermia?

Unlabelled: Anesthesiologists attempt to maintain perioperative normothermia for surgical patients. We surveyed clinical anesthesiologists and physician researchers and asked them to prioritize risk factors for a patient to develop intraoperative hypothermia. The questionnaire included 41 factors associated with changes in patient temperature identified during a computerized literature search.

Operating room managers' use of integer programming for assigning block time to surgical groups: a case study.

Unlabelled: A common problem at hospitals with fixed amounts of available operating room (OR) time (i.e., "block time") is determining an equitable method of distributing time to surgical groups.

Calculating a potential increase in hospital margin for elective surgery by changing operating room time allocations or increasing nursing staffing to permit completion of more cases: a case study.

Unlabelled: Administrators routinely seek to increase contribution margin (revenue minus variable costs) to better cover fixed costs, provide indigent care, and meet other community service responsibilities. Hospitals with high operating room (OR) utilizations can allocate OR time for elective surgery to surgeons based partly on their contribution margins per hour of OR time. This applies particularly when OR caseload is limited by nursing recruitment.

Relative value guide basic units in operating room scheduling to ensure compliance with anesthesia group policies for surgical procedures performed at each anesthetizing location.

Many anesthesia groups provide services in a spectrum of anesthetizing locations, including offices, free-standing ambulatory surgery centers, diagnostic clinics, and traditional hospital operating rooms. The use of a uniformly understood measure of case complexity could assist an anesthesia group in ensuring appropriate anesthesia provider expertise and equipment availability at each anesthetizing location. In this article, we show how the American Society of Anesthesiologists' Relative Value Guide (ASA RVG) basic units can be used as a criterion to establish the maximum level of complexity of cases performed at each location by an anesthesia group.

Brain expression of inducible cyclooxygenase 2 messenger RNA in rats undergoing cardiopulmonary bypass.

Background: We hypothesized that systemic proinflammatory cytokines or endotoxemia, or both, associated with cardiopulmonary bypass (CPB) would increase expression of inducible cyclooxygenase (COX-2) or inducible nitric oxide synthase (iNOS) messenger RNA (mRNA), or both, in brain.

Methods: Isoflurane-anesthetized Sprague-Dawley rats were randomly selected for CPB (n = 6) or sham surgery (n = 6). All animals underwent tracheotomy and controlled ventilation, arterial and venous pressure monitoring, insertion of a jugular venous outflow catheter, insertion of a subclavian arterial inflow catheter, systemic anticoagulation (500 U/kg heparin) and, except during CPB, servoregulation of pericranial temperature at 37.

Weekend operating room on call staffing requirements.

This article describes a statistical method used to determine the minimum number of OR teams that should be on call for urgent procedures, in-house versus on standby from home, to minimize labor costs. The OR manager obtains the number of ORs staffed at each hour of the 24-hour period of interest (e.g.

Reducing family members' anxiety while waiting on the day of surgery: systematic review of studies and implications of HIPAA health information privacy rules.

Study Objective: To investigate changes that most surgical suites will need to make in the process of giving reports to family members on the day of surgery by the compliance date (April 14, 2003) of the privacy regulations of the Health Insurance Portability and Accountability Act (HIPPA) of 1996.

Design: Systematic review of the medical literature on ways in which providing information to family members changes their anxiety.

Measurements: The endpoints of the controlled studies included Spielberger State Anxiety.

Hospital profitability per hour of operating room time can vary among surgeons.

The operating margins (i.e., profits) of hospitals are decreasing.

A statistical analysis of weekday operating room anesthesia group staffing costs at nine independently managed surgical suites.

Unlabelled: At many surgical suites, surgeons and patients schedule elective cases on whatever future workday they choose, resulting in there being no limit on the number of cases performed each day. Staff are then scheduled in the manner that satisfies the marketing guarantee to the surgeons, satisfies labor contracts, and minimizes staffing costs. We assessed weekday nurse anesthesia group staffing at nine such suites to determine whether statistical methods can identify staffing solutions whereby all the cases are covered but for which staffing costs are less than those obtained using the staffing plans implemented by anesthesia groups' managers.

The impact on revenue of increasing patient volume at surgical suites with relatively high operating room utilization.

Unlabelled: We previously studied hospitals in the United States of America that are losing money despite limiting the hours that operating room (OR) staff are available to care for patients undergoing elective surgery. These hospitals routinely keep utilization relatively high to maximize revenue. We tested, using discrete-event computer simulation, whether increasing patient volume while being reimbursed less for each additional patient can reliably achieve an increase in revenue when initial adjusted OR utilization is 90%.

Optimal number of beds and occupancy to minimize staffing costs in an obstetrical unit?

Purpose: We describe how the science of analyzing patient arrival and discharge data can be used to determine the optimal number of staffed OB beds to minimize labour costs.

Methods: The number of staffed beds represents a balance between having as few staffed beds as possible to care properly for parturients vs having enough capacity to assure available staff for new admissions. The times of admission and discharge of patients from the OB unit can be used to calculate an average census.

Scheduling a delay between different surgeons' cases in the same operating room on the same day using upper prediction bounds for case durations.

Unlabelled: At some surgical suites, elective cases are only scheduled if they can be completed during regularly scheduled hours. At such a surgical suite, a surgeon may be scheduled to perform one or more cases in an operating room (OR), to be followed by another surgeon who will perform one or more cases. Scheduling a delay between the two surgeons' cases will improve the likelihood that the second surgeon's case(s) will start on time.

Cost identification analysis for succinylcholine.

Unlabelled: The cost of a dose of succinylcholine from society's perspective equals the acquisition cost of the drug plus the cost of its adverse outcomes. We hypothesized that although the acquisition cost of succinylcholine is minimal, the true cost would be much larger. We reviewed the medical literature to identify the total cost of a dose of succinylcholine when administered for nonemergency purposes according to manufacturers' guidelines (i.

The lack of systematic month-to-month variation over one-year periods in ambulatory surgery caseload -application to anesthesia staffing.

Anesthesia groups forecast future workload so that staffing and future hiring can be adjusted. Statistical methods have been developed to estimate the number of anesthesia providers needed to minimize labor costs during regularly scheduled hours, second-shifts, and weekends. These methods are simple, in that they assume that, on this medium-range (11-mo) basis, workload varies irregularly around a mean workload.