Changing Anesthesia Block Allocations Improves Endoscopy Suite Efficiency

Mitchell H Tsai; Michael A Hall; Melanie S Cardinal; Max W Breidenstein; Michael J Abajian; Richard S Zubarik

doi:10.1007/s10916-019-1451-x

Changing Anesthesia Block Allocations Improves Endoscopy Suite Efficiency

J Med Syst. 2019 Nov 15;44(1):1. doi: 10.1007/s10916-019-1451-x.

Authors

Mitchell H Tsai^{1

2

3}, Michael A Hall⁴, Melanie S Cardinal⁵, Max W Breidenstein⁶, Michael J Abajian⁷, Richard S Zubarik⁸

Affiliations

¹ Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, VT, USA. Mitchell.Tsai@uvmhealth.org.
² Department of Orthopedics and Rehabilitation (by courtesy), University of Vermont Larner College of Medicine, Burlington, VT, USA. Mitchell.Tsai@uvmhealth.org.
³ Department of Surgery (by courtesy), University of Vermont Larner College of Medicine, Burlington, VT, USA. Mitchell.Tsai@uvmhealth.org.
⁴ Anesthesia Services, P.A., Department of Anesthesiology, Christiana Care Health System, Newark, DE, USA.
⁵ Green Mountain Surgery Center, Colchester, VT, USA.
⁶ Department of Anesthesiology, University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT, USA.
⁷ Department of Nursing, University of Vermont College of Nursing and Health Sciences, Burlington, VT, USA.
⁸ Department of Internal Medicine, Division of Gastroenterology, University of Vermont Larner College of Medicine, Burlington, VT, USA.

PMID: 31741075
DOI: 10.1007/s10916-019-1451-x

Abstract

Non-operating room anesthesia (NORA) has grown and continues to expand as a proportion of all anesthesia practice in the United States [1, 2]. While many management processes have been adapted for NORA from the traditional operating room, it is still unclear what scheduling paradigm will maximize efficiency of resource utilization in this arena. In this study, we investigate the impact of tactical a shift from a shared group to individual, provider-specific block allocations for available anesthesia time in an endoscopy suite for adult patients undergoing elective endoscopy procedures at an academic hospital. Using a retrospective and prospective analysis, we measured elective time-in-block; elective time out-of-block; under-utilized (opportunity and non-opportunity unused) time; over-utilized time; and case tardiness to determine operational efficiency and clinical productivity. Over the study period, the monthly caseload remained constant. Elective time in block increased by 156% (p < 0.0001) and elective time out of block decreased by 38% (p < 0.0001). Opportunity unused time decreased by 28% (p < 0.0001) and productivity increased by 51% (p < 0.0001). Neither over-utilized time nor case tardiness showed a significant change after the intervention. Despite the evidence base supporting traditional approaches to anesthesia block allocation involving group block allocation and non-sequential case scheduling, we have demonstrated an advantage to individual block allocation in a GI endoscopy setting. This sequential case scheduling highlights how tactical decisions in NORA environments may require a rethinking of many practices that anesthesiologists have brought with them from the traditional OR. Using these efficiency and productivity metrics, further adjustments to scheduling practices should be investigated, and connecting these metrics to other systems outcomes, such as financial productivity, is an important next step as NORA services expand into the future.

Keywords: Endoscopy; Non-operating room anesthesia; Scheduling; Statistical process control; Tactical decisions; Under-utilized time.

MeSH terms

Anesthesia / trends*
Anesthesiology / trends
Efficiency, Organizational / trends*
Humans
Operating Rooms / trends*
Patient Care Team / trends*
Retrospective Studies