Richard H Epstein1, Franklin Dexter2, Eric S Schwenk3, Thomas A Witkowski4. 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; Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, United States. Electronic address: repstein@med.miami.edu. 2. Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242, United States. Electronic address: franklin-dexter@uiowa.edu. 3. Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, United States,. Electronic address: eric.schwenk@jefferson.edu. 4. Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, United States. Electronic address: thomas.witkowsk@jefferson.edu.
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.
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.