Implications of Patient Age and ASA Physical Status for Operating Room Management Decisions.

Lüdi, Markus; Kauf, Peter; Mulks, Lisa; Wieferich, Katharina; Schiffer, Ralf; Doll, Dietrich (2016). Implications of Patient Age and ASA Physical Status for Operating Room Management Decisions. Anesthesia and analgesia, 122(4), pp. 1169-1177. Lippincott Williams & Wilkins 10.1213/ANE.0000000000001187

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BACKGROUND In elderly, high-risk patients, operating room (OR) turnaround times are especially difficult to estimate, and the managerial implications of patient age and ASA physical status for OR management decisions remain unclear. We hypothesized that evaluating patient age and ASA physical status in the right model would improve accuracy of turnaround time estimates and, thus, would have decisive implications for OR management. METHODS By using various multivariate techniques, we modeled turnaround times of 13,632 OR procedures with respect to multiple variables including surgical list, age, ASA physical status, duration of the procedure, and duration of the preceding procedure. We first assessed correlations and general descriptive features of the data. Then, we constructed decision tables for OR management consisting of 50th and 95th percentiles of age/ASA-dependent estimates of turnaround times. In addition, we applied linear and generalized linear multivariate models to predict turnaround times. The forecasting power of the models was assessed in view of single cases but also in view of critical managerial key figures (50th and 95th percentile turnaround times). The models were calibrated on 80% of the data, and their predictive value was tested on the remaining 20%. We considered our data in a Monte Carlo simulation to deduce actual reductions of overutilized OR time when applying the results as presented in this work. RESULTS Using the best models, we achieved an increase in predictive accuracy of 7.7% (all lists), ranging from 2.5% (general surgery) to 21.0% (trauma surgery) relative to age/ASA-independent medians of turnaround times. All models decreased the forecasting error, signifying a relevant increase in planning accuracy. We constructed a management decision table to estimate age/ASA-dependent turnaround time for OR scheduling at our hospital. CONCLUSIONS The decision tables allow OR managers at our hospital to schedule procedures more accurately. Evaluation of patient age and ASA physical status as variables can help to better predict turnaround times, which can facilitate scheduling, for example, to schedule overlapping induction rooms, to reduce overutilized OR time by optimizing allocation of patients to several ORs, and to improve logistics of prioritizing transportation of advanced age/high ASA physical status patients to the OR.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Lüdi, Markus

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0003-2999

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

11 Jan 2017 17:08

Last Modified:

23 Jan 2018 12:14

Publisher DOI:

10.1213/ANE.0000000000001187

PubMed ID:

26991621

BORIS DOI:

10.7892/boris.92460

URI:

https://boris.unibe.ch/id/eprint/92460

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