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A System-Wide Approach to Physician Efficiency and Utilization Rates for Non-Operating Room Anesthesia Sites

  • Systems-Level Quality Improvement
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Abstract

There has been little in the development or application of operating room (OR) management metrics to non-operating room anesthesia (NORA) sites. This is in contrast to the well-developed management framework for the OR management. We hypothesized that by adopting the concept of physician efficiency, we could determine the applicability of this clinical productivity benchmark for physicians providing services for NORA cases at a tertiary care center. We conducted a retrospective data analysis of NORA sites at an academic, rural hospital, including both adult and pediatric patients. Using the time stamps from WiseOR® (Palo Alto, CA), we calculated site utilization and physician efficiency for each day. We defined scheduling efficiency (SE) as the number of staffed anesthesiologists divided by the number of staffed sites and stratified the data into three categories (SE < 1, SE = 1, and SE >1). The mean physician efficiency was 0.293 (95% CI, [0.281, 0.305]), and the mean site utilization was 0.328 (95% CI, [0.314, 0.343]). When days were stratified by scheduling efficiency (SE < 1, =1, or >1), we found differences between physician efficiency and site utilization. On days where scheduling efficiency was less than 1, that is, there are more sites than physicians, mean physician efficiency (95% CI, [0.326, 0.402]) was higher than mean site utilization (95% CI, [0.250, 0.296]). We demonstrate that scheduling efficiency vis-à-vis physician efficiency as an OR management metric diverge when anesthesiologists travel between NORA sites. When the opportunity to scale operational efficiencies is limited, increasing scheduling efficiency by incorporating different NORA sites into a “block” allocation on any given day may be the only suitable tactical alternative.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, VT, USA

    Mitchell H. Tsai, Tinh T. Huynh, Max W. Breidenstein & Stephen E. O’Donnell

  2. Department of Orthopaedics and Rehabilitation (by courtesy), University of Vermont Larner College of Medicine, Burlington, VT, USA

    Mitchell H. Tsai

  3. Departments of Anesthesiology, Surgery, Biomedical Informatics, and Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA

    Jesse M. Ehrenfeld

  4. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Richard D. Urman

Authors
  1. Mitchell H. Tsai
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  2. Tinh T. Huynh
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  3. Max W. Breidenstein
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  4. Stephen E. O’Donnell
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  5. Jesse M. Ehrenfeld
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  6. Richard D. Urman
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Contributions

Mitchell H. Tsai, MD, MMM

Contribution: this author helped design and prepare the manuscript.

Tinh T. Huynh, BS

Contribution: this author helped design and prepare the manuscript.

Max W. Breidenstein, BS

Contribution: this author helped design and prepare the manuscript.

Stephen E. O’Donnell, MD

Contribution: this author helped design and prepare the manuscript.

Jesse M. Ehrenfeld, MD, MPH

Contribution: this author provided critical edits to the manuscript.

Richard D. Urman, MD, MBA

Contribution: this author helped design and prepare the manuscript.

Corresponding author

Correspondence to Mitchell H. Tsai.

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Conflict of Interest

Richard Urman has received research grants from Merck, Mallinckrodt, and Medtronic. Other Authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Informed consent was not required for this study.

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This article is part of the Topical Collection on Systems-Level Quality Improvement

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Tsai, M.H., Huynh, T.T., Breidenstein, M.W. et al. A System-Wide Approach to Physician Efficiency and Utilization Rates for Non-Operating Room Anesthesia Sites. J Med Syst 41, 112 (2017). https://doi.org/10.1007/s10916-017-0754-z

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  • DOI: https://doi.org/10.1007/s10916-017-0754-z

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