Researchers are creating a set of national benchmarks to estimate times in which anesthesia takes effect for different procedures. Knowing average intraoperative anesthesia ready times could help hospital administrators and anesthesiology departments improve intraoperative efficiency with better scheduling and optimized use of anesthesiologists.
Sudheer K. Jain, MD, assistant clinical director of the Department of Anesthesiology, and third-year anesthesiology resident Lori Russo, MD, of NYU Langone Medical Center, New York City, discussed their ongoing research at the annual meeting of the American Society of Anesthesiologists.
As hospital administrators are requiring health care providers to become more cost-effective and efficient, they have begun to take a closer look at anesthesiologists. Anesthesiologists at busy institutions are being encouraged to shorten their anesthesia induction times, but absent national benchmarks health care providers might be pressured into unrealistic expectations, potentially resulting in adverse outcomes.
“Our hospital has a lot of pressure to make things move [more] quickly and anesthesia is something they often look at. There’s no real existing data on this and we wanted to see how long things should take,” Dr. Russo said.
Their research examined the anesthesia induction times for 22,604 cases performed at the institution over the nine-month period from April to December 2013. Cases were categorized by the hospital’s 74 most common surgical procedure types, ranging from spinal fusion and craniotomy to bowel resection. Average times were recorded from the moment the patients were wheeled into the operating room until the time they were ready for the surgical procedure and positioning.
Dr. Jain said the hospital previously based its scheduling models from incision to surgical end time without factoring in anesthesia. Over the course of a day, those incorrect calculations were adding up to significant time delays and putting additional pressure on anesthesiologists.
“It’s really important to [factor in] anesthesia ready times because there can be a lot of time involved in it. There can be a significant variability for certain types of cases and it can make a big impact in scheduling,” said Dr. Jain.
The researchers studied a large number of cases to get a more detailed analysis in order to differentiate ready times based on the anesthetic procedures performed as well as staffing considerations. Data will be analyzed based on type of anesthesia and how it was administered, and Dr. Russo said they are also tracking the number and types of health care workers involved in the delivery of the anesthesia. Times might vary if there was a certified registered nurse anesthetist or resident in the room.
Dr. Russo said using as many factors as possible could help create more accurate benchmarks for anesthesia start times. She said they’ve already discovered valuable information that could help determine precise anesthesia times for surgery planning. Surgical schedulers will be able to say, for example, that the anesthesiologist may need up to 44 minutes to get a patient having coronary artery bypass graft surgery ready for incision, whereas an anesthesiologist preparing a patient for total hip arthroplasty may need an average of 18 minutes.
“We want to be able to say this is exactly the time we need to start. We can try to improve upon that and also create more realistic schedules,” said Dr. Russo.
In addition to establishing benchmarks, Dr. Jain said the information could also help identify ways to decrease anesthesia start times or improve efficiencies. Solutions may include shifting some procedures outside of the operating room or adjusting staffing for certain procedures.