Bypass of an anesthesiologist-directed preoperative evaluation clinic results in greater first-case tardiness and turnover times

Richard H. Epstein, Franklin Dexter, Eric S. Schwenk, Thomas A. Witkowski

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Study objective We 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. Design Retrospective observational study using electronic health records. Setting One large, teaching hospital. Patients An 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. Interventions None. Measurements Average increases in first-case tardiness and turnover times between patients seen or not seen preoperatively in the APEC. Main results APEC 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. Conclusions Overall 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.

Original languageEnglish (US)
Pages (from-to)112-119
Number of pages8
JournalJournal of Clinical Anesthesia
Volume41
DOIs
StatePublished - Sep 2017

Keywords

  • Economics, hospital
  • Efficiency, organizational
  • Operating room information systems
  • Preoperative care

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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