Bypass of an anesthesiologist-directed preoperative evaluation clinic results in greater first-case tardiness and turnover times |
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| Institution: | 1. Department of Anesthesiology, Pain Management and Perioperative Medicine, University of Miami, Miller School of Medicine, 1400, NW, 12th Avenue, Suite 3075, Miami, Florida 33136, United States;2. Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, United States;3. Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242, United States;4. Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, United States,;5. Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, United States;1. Division of Management University of Iowa, Iowa City, Iowa, USA;2. University of Miami, Miami, Florida, USA;3. Uppsala University, Västerås, Sweden;4. University of Iowa, Iowa City, Iowa, USA;1. University of Utah, United States of America;2. Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, 6-JCP, Iowa City, IA 52242, United States of America;3. Broken Hill Base Hospital, Broken Hill, 2880, NSW, Australia;4. Department of Anesthesiology, Pain Management and Perioperative Medicine, University of Miami, United States of America;1. Department of Anesthesia, University of Iowa, Iowa City, Iowa;2. Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa;3. Department of Anesthesiology, University of Miami, Miami, Florida;1. Department of Communication Arts, University of Wisconsin, Madison, WI, USA;2. Division of Management Consulting, Department of Anesthesia, University of Iowa, IA, USA;3. Department of Anesthesiology, University of Florida, FL, USA;4. Department of Communication Arts, University of Wisconsin, Madison, WI, USA;1. Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA;2. Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA;3. Perioperative Services, Massachusetts General Hospital, Boston, MA 02114, USA;4. Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA |
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| Abstract: | Study objectiveWe evaluated 4 hypotheses related to bypass of an anesthesiologist-directed preoperative evaluation clinics (APEC): 1) first-case tardiness and turnover times increased; 2) turnover times increased more than first-case tardiness; and higher American Society of Anesthesiologists Physical Status (ASA PS) resulted in both an ordered increase among ASA PS and within ASA PS in 3) first-case tardiness; and 4) turnover times.DesignRetrospective observational study using electronic health records.SettingOne large, teaching hospital.PatientsAn average of 14,310 patients per year undergoing elective surgery in the hospital's main opera rating rooms who were not inpatients preoperatively between 2006 and 2016.InterventionsNone.MeasurementsAverage increases in first-case tardiness and turnover times between patients seen or not seen preoperatively in the APEC.Main resultsAPEC bypass increased first-case tardiness 2.58 min per case (CI 1.55–3.61; P < 0.0001) and turnover times by 7.49 min (CI 6.79–8.19; P < 0.0001). The increase in mean turnover time was greater than mean first-case tardiness (difference = 4.91 min; CI 3.76–6.06; P < 0.0001). Had all patients bypassed the APEC, the increase in total minutes OR− 1 workday− 1 for turnover times would have been larger than the increase in first-case tardiness (difference = 5.71, CI 3.17–4.72; P < 0.0001). There was an ordered increase with APEC bypass for both first-case tardiness and turnover times with increasing ASA PS (P < 0.0001). Within ASA PS, first-case tardiness (all P-values < 0.003) and turnover times (all P-values < 0.0001) also increased with APEC bypass. All 4 hypotheses were accepted.ConclusionsOverall and with control for ASA PS, APEC bypass increases first-case tardiness and turnover times. A strategy of selective bypass of ASA PS 1–2 patients would not be effective economically because of substantial delays from ASA PS 2 patients. |
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