Sarah S Titler1, Franklin Dexter1, Richard H Epstein2. 1. Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA. 2. Department of Anesthesiology, University of Miami, Coral Gables, Florida, USA.
Abstract
Objective: Coordinating breast milk pumping sessions is challenging for lactating anesthesiologists who supervise multiple simultaneous anesthetics. We quantify the minimum percentages of adjacent operating rooms (ORs) for which there could reliably (≥95%) be at least 30 minutes during the surgical time when the anesthesiologist covering three anesthetics could have her rooms covered by another anesthesiologist. Methods: The historical cohort study was from a large U.S. teaching hospital. We calculated the 5% lower prediction bounds of surgical times from 3 years of historical data, and then applied them to surgical start times from adjacent ORs during the next 1 year. Results: For >2/3rd of cases, an anesthesiologist supervising three ORs would lack a reliable 30-minute period of overlapping surgical times, and an even smaller chance per case at the ambulatory surgery center, 10% (9-11%). For approximately 42% (41-43%) of sufficiently long individual cases, there was absence of a 30-minute period during which both of the two adjacent ORs' cases were suitable for the anesthesiologist to receive a break (p < 0.0001 compared with one-third). Conclusions: Even when making assumptions that were deliberately unrealistic (e.g., anesthesiologists' responsibilities are only for ongoing OR cases), there is no practical mechanism for an anesthesiologist supervising three ORs to start cases, be relieved for a breast milk pumping session, and then return in time for the end of the anesthetics (e.g., tracheal extubation). Departments with anesthesiologists who are breastfeeding should consider having options for temporary clinical assignments, commensurate with training and experience, that do not require supervising >2 ORs.
Objective: Coordinating breast milk pumping sessions is challenging for lactating anesthesiologists who supervise multiple simultaneous anesthetics. We quantify the minimum percentages of adjacent operating rooms (ORs) for which there could reliably (≥95%) be at least 30 minutes during the surgical time when the anesthesiologist covering three anesthetics could have her rooms covered by another anesthesiologist. Methods: The historical cohort study was from a large U.S. teaching hospital. We calculated the 5% lower prediction bounds of surgical times from 3 years of historical data, and then applied them to surgical start times from adjacent ORs during the next 1 year. Results: For >2/3rd of cases, an anesthesiologist supervising three ORs would lack a reliable 30-minute period of overlapping surgical times, and an even smaller chance per case at the ambulatory surgery center, 10% (9-11%). For approximately 42% (41-43%) of sufficiently long individual cases, there was absence of a 30-minute period during which both of the two adjacent ORs' cases were suitable for the anesthesiologist to receive a break (p < 0.0001 compared with one-third). Conclusions: Even when making assumptions that were deliberately unrealistic (e.g., anesthesiologists' responsibilities are only for ongoing OR cases), there is no practical mechanism for an anesthesiologist supervising three ORs to start cases, be relieved for a breast milk pumping session, and then return in time for the end of the anesthetics (e.g., tracheal extubation). Departments with anesthesiologists who are breastfeeding should consider having options for temporary clinical assignments, commensurate with training and experience, that do not require supervising >2 ORs.
Keywords:
anesthesiology; breast milk pumping session; lognormal distribution; staff assignment; staff scheduling; surgical times