Many US hospital-affiliated freestanding ambulatory surgery centers are located on hospital campuses, relevant to interpretation of studies involving ambulatory surgery

Perioperative Care and Operating Room Management

Epstein

Marian

2020

Self Cite

Background An “unscheduled absence” refers to an occurrence when an employee does not appear for work and the absence was without advance approval by an authorized supervisor. Recently we estimated the prevalence of unscheduled absences in a cohort of certified registered nurse anesthetists at the University of Miami. We performed a historical cohort study for all types of anesthesia practitioners at the University of Iowa. Methods Two-years of person-assignment days were studied. The total population was 62,951 regular operating room days among 293 people. There were 56,437 days among 203 practitioners with multiple workdays over multiple quarters. Results In the total population, the 91 nurse anesthetists had 1.48% person-days with an unscheduled absence, comparable to the 1.74% from University of Miami. Most unscheduled absences (99% lower confidence limit 80.1%) resulted in the person being absent from an operating room clinical assignment for just 1 day. Compared with nurse anesthetists, residents and fellows had proportionately fewer unscheduled absences (odds ratio 0.24 [0.13-0.45], P <.0001), as did anesthesiologists (0.49 [0.30-0.79], P =.0002). Among all practitioners, Mondays, Fridays, and days adjacent to holidays had significantly more unscheduled absences than Tuesdays, Wednesdays, and Thursdays (1.45 [1.19-1.76], P <.0001). Conclusions To have an adequate daily workforce, anesthesia clinical directors need to estimate the daily expected percentage of assigned anesthesia practitioners who will be absent. Potential inter-group differences should be considered. We provide a worked example showing how to use the results to decide numbers of practitioners to plan daily.

Section: Methodsmentioning

confidence: 99%

Comparisons of unscheduled absences among categories of anesthesia practitioners, including anesthesiologists, nurse anesthetists, and anesthesia residents

Perioperative Care and Operating Room Management

Epstein

Marian

2020

Self Cite

“…However, ambulatory surgery accounts for 74.7% of surgical cases performed on regular workdays (i.e., non-urgent) [7,8]. Essential and highpriority elective surgery that can expand earliest comprise procedures that can be performed safely in free-standing buildings, whether in hospital outpatient departments or at facilities unaffiliated with hospitals [9]. Although we refer to ambulatory "surgery," our intention is for the principles to apply fully to all procedures, whether or not an anesthesia provider is involved in the care of the patient (e.g., includes brief interventional pain procedures with known efficacy [e.g., single transforaminal epidural steroid injection for new-onset pain]) [10].…”

Section: Introductionmentioning

confidence: 99%

Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic

Journal of Clinical Anesthesia

Elhakim

Loftus

et al. 2020

Self Cite

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

“…The surgical cases were performed in the main adult surgical suites, the ambulatory surgery center, or the pediatric suite ORs at the studied hospital, all located within a five-minute indoor walk of one another [ 7 ]. The cases were limited to those that were elective, defined by the organization as the surgeon having specified that the patient could wait safely at least three days for surgery (i.e., from Friday to Monday).…”

Section: Methodsmentioning

confidence: 99%

Forecasting the Probability That Each Surgical Case Will Either Be Ambulatory or the Patient Will Remain in the Hospital Overnight Versus Having a Length of Stay of Two or More Days

Epstein

Shi

2020

Cureus

Self Cite

When the hospital census is high, perioperative medical directors or operating room (OR) managers sometimes need to review with surgical departments as to which surgical cases scheduled to be performed within the next three days may need to be postponed. Although distributions of hospital length of stay (LOS) are highly skewed, a surprisingly effective summary measure is the percentage of patients previously undergoing the same category of procedure as that scheduled whose LOS was zero or one day. We evaluated how to forecast each hospital's percentage of cases with LOS of <2 days, segmented by category of surgical procedure. The large teaching hospital studied included several inpatient adult surgical suites, an ambulatory surgery center, and a pediatric surgical suite. We included 98,540 cases in a training dataset to predict 24,338 cases in a test dataset. For each category of procedure, we calculated the cumulative count of cases among quarters, from the most recent quarter, second most recent quarter, and so forth up to the quarter resulting in at least 800 cases. If every quarter combined had fewer than 800 cases for a given category of procedure, we included all cases for that category. For each combination of category and quarter, we used the cumulative counts of cases and cases with LOS of <2 days, excluding the current quarter. Then, for each category of procedure, and for each of the preceding quarters included for the category, we used the cumulative counts to calculate the asymptotic standard error (SE) for the proportion of cases with LOS of <2 days. If all preceding quarters combined provided a sample size such that the estimated SE for the proportion exceeded 1.25%, we included all preceding quarters. The observed absolute percentage error was 0.76% (SE: 0.12%). This error was nearly 100-fold smaller than the percentage of cases to which it would be used (i.e., 0.76% versus 73.1% with LOS of <2 days). The principal weakness of the forecasting methodology was a small bias caused by a progressive reduction in the overall LOS over time. However, this bias is unlikely to be important for predicting cases' LOS when the hospital census is high. When performing these time series calculations quarterly, a reasonable approach is to perform calculations of both case counts and SEs for each category of procedure. We recommend using the fewest historical quarters, starting with the most recent quarter, either with at least 800 cases or an estimated asymptotic SE for the estimated percentage no greater than 1.25%. Applying our methodology with local LOS data will allow OR managers to estimate the number of patients on the elective OR schedule each day who will be hospitalized for longer than overnight, facilitating communication and decisionmaking with surgical departments when census considerations constrain the ability to run a full surgical schedule.