Estimating the time needed for induction of anaesthesia and its importance in balancing anaesthetists’ and surgeons’ waiting times around the start of surgery

Koenig, Titus R.; Neumann, Christian; Ocker, T.; Krämer, Sabine; Spies, C.; Schuster, Martín

doi:10.1111/j.1365-2044.2011.06661.x

Cited by 38 publications

(28 citation statements)

References 23 publications

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“…In an effort to estimate the time needed for induction of anaesthesia, Koenig et al [17] recorded a mean time of about 10 min needed for applying only a laryngeal mask, about 15 min for tracheal intubation only, and about 25 min for intubation plus arterial line; the differences between the anaesthetic techniques regarding induction time are statistically significant, which are in line with our findings. In the same manner, in an audit of females subjected to gynaecology surgery, the time interval for induction of general anaesthesia ranged between 5 and 17 min in cases when anaesthesia was provided via only a peripheral vein [15].…”

Section: Discussionsupporting

confidence: 90%

“…Additionally, in several cases, central venous or radial artery catheter insertion was carried out simultaneously following tracheal intubation, thus ensuring some minutes being saved over the total operation time. In any case, process time might be influenced by the performance level of the individual anaesthetist, or by other specific factors such as shortage of instruments or of staff [17]. …”

Section: Discussionmentioning

confidence: 99%

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An Audit of Operating Room Time Utilization in a Teaching Hospital: Is There a Place for Improvement?

et al. 2014

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Aim. To perform a thorough and step-by-step assessment of operating room (OR) time utilization, with a view to assess the efficacy of our practice and to identify areas of further improvement. Materials and Methods. We retrospectively analyzed the most ordinary general surgery procedures, in terms of five intervals of OR time utilization: anaesthesia induction, surgery preparation, duration of operation, recovery from anaesthesia, and transfer to postanaesthesia care unit (PACU) or intensive care unit (ICU). According to their surgical impact, the procedures were defined as minor, moderate, and major. Results. A total of 548 operations were analyzed. The mean (SD) time in minutes for anaesthesia induction was 19 (9), for surgery preparation 13 (8), for surgery 115 (64), for recovery from anaesthesia 12 (8), and for transfer to PACU/ICU 12 (9). The time spent in each step presented an ascending escalation pattern proportional to the surgical impact (P = 0.000), which was less pronounced in the transfer to PACU/ICU (P = 0.006). Conclusions. Albeit, our study was conducted in a teaching hospital, the recorded time estimates ranged within acceptable limits. Efficient OR time usage and outliers elimination could be accomplished by a better organized transfer personnel service, greater availability of anaesthesia providers, and interdisciplinary collaboration.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

An Audit of Operating Room Time Utilization in a Teaching Hospital: Is There a Place for Improvement?

et al. 2014

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“…Instead, the primary focus should be towards quantitative improvements in list scheduling. ('knife-to-skin'), because if one of these is fixed then the other follows automatically as a probabilistic estimate [6]. All that matters is that a clear, pre-agreed definition exists within an institution.…”

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confidence: 99%

Is ‘starting on time’ useful (or useless) as a surrogate measure for ‘surgical theatre efficiency’?*

et al. 2012

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We analysed more than 7000 theatre lists from two similar UK hospitals, to assess whether start times and finish times were correlated. We also analysed gap times (the time between patients when no anaesthesia or surgery occurs), to see whether these affected theatre efficiency. Operating list start and finish times were poorly correlated at both hospitals (r 2 = 0.077 and 0.043), and cancellation rates did not increase with late starts (remaining within 2% and 10%respectively at the two hospitals). Start time did not predict finish time (receiver operating curve areas 0.517 and 0.558, respectively), and did not influence theatre efficiency ($80-84% at either hospital). Median gap times constituted just 7% of scheduled list time and did not influence theatre efficiency below cumulative gap times of less than 15% scheduled list time. Lists with no gaps still exhibited extremely variable finish times and efficiency. We conclude that resources expended in trying to achieve prompt start times in isolation, or in reducing gap times to under $15% of scheduled list time, will not improve theatre productivity. Instead, the primary focus should be towards quantitative improvements in list scheduling. ('knife-to-skin'), because if one of these is fixed then the other follows automatically as a probabilistic estimate [6]. All that matters is that a clear, pre-agreed definition exists within an institution. Prompt starts would seem important. If a list starts late, it should be expected to finish late. With late starts, the scheduled time (which has been budgeted in advance) will be wasted and with late finishes, unbudgeted overtime costs are incurred, with the attendant risk of unplanned patient cancellation. Several studies, however, have found a very high prevalence of non- Anaesthesia 2012Anaesthesia , 67, 823-832 doi:10.1111Anaesthesia /j.1365Anaesthesia -2044Anaesthesia .2012 Consequently, start times are monitored routinely within many NHS Trusts, and are used both as local 'key performance indicators' to guide planning, and, occasionally, to pressurise individuals or teams to change behaviour, attitudes or policies [11,12]. The Foundation Trust Network has promoted start times as a key target [13] and the Royal College of Anaesthetists has suggested that fewer than 10% of lists should start more than 10 min late [14]. However, whilst the published evidence has found that late starts are frequent, it does not indicate that late starts affect theatre efficiency. Furthermore, there is no evidence to substantiate the Royal College's suggestion that 10 min should be a relevant time boundary when defining a 'late start'. Indeed, Macario has suggested (but without citing data to support the claim) that late starts of up to 45 min remain consistent with efficient performance [15,16].The main aim of this study was to test the hypothesis that start time was an important determinant of operating list efficiency. Specifically, we predicted that lists that started late would end late and be less efficient.As late starts rep...

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“…This statement was prudent when the surgical procedure length stayed within these confines. Many surgical procedures performed in outpatient settings are routinely in excess of 1.5 h, which adds to recovery room length of stay and alters fluid management; pain control can become more challenging and the need for voiding prior to discharge can require a catheter [24].…”

Section: Surgical Procedures Length Scope and 'Healthspan'mentioning

confidence: 99%

Providing value in ambulatory anesthesia

Fosnot¹,

Fleisher²,

Keogh

2015

Current Opinion in Anaesthesiology

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Ambulatory anesthesia's popularity continues to rise and anesthetic techniques will continue to morph and adapt to the needs of patients seeking ambulatory surgery. Alterations in already existing medications are promising as these modifications allow for quicker recovery from anesthesia or minimization of the already known undesirable side-effects. PONV, pain, obstructive sleep apnea, and chronic comorbidities (hypertension, cardiac disease, and diabetes mellitus) are perioperative concerns in ambulatory settings as more patients are safely being treated in ambulatory settings. Regional anesthesia stands out as a modality that has multiple advantages to general anesthesia, providing a minimal recovery period and a decrease in postanesthesia care unit stay. The implementation of the Affordable Healthcare Act specifically affects ambulatory settings as the demand and need for patients to have screening procedures with anesthesia. The question remains what the best strategy is to meet the needs of our future patients while preserving economically feasibility within an already strained healthcare system.

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Estimating the time needed for induction of anaesthesia and its importance in balancing anaesthetists’ and surgeons’ waiting times around the start of surgery

Cited by 38 publications

References 23 publications

An Audit of Operating Room Time Utilization in a Teaching Hospital: Is There a Place for Improvement?

An Audit of Operating Room Time Utilization in a Teaching Hospital: Is There a Place for Improvement?

Is ‘starting on time’ useful (or useless) as a surrogate measure for ‘surgical theatre efficiency’?*

Providing value in ambulatory anesthesia

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