Monitoring changes in individual surgeon’s workloads using anesthesia data

Abstract

Purpose We investigated whether changes in the number of cases performed by surgeons can be used as an appropriate surrogate for anesthesia departments' billed units. Methods We used both number of cases performed and the American Society of Anesthesiologists' Relative Value Guide TM (ASA RVG) units to assess all operating room anesthetics of an anesthesia group for two sets of 13 fourweek periods. The units correspond to Canadian basic units and time units. Results Although the number of ASA RVG units is an economically important variable that quantifies perioperative workload, the number of cases is a suitable surrogate for ASA RVG units when used to monitor individual surgeons. The pooled mean Pearson correlation coefficient between the two variables was r = 0.95, with 95% confidence interval 0.94 to 0.96. In addition, there were essentially none to very weak pairwise correlations among surgeons. Conclusions Informal hospital analyses of relative changes in a surgeon's caseload over one year using anesthesia workload data or anesthesia billing data will generally give equivalent results. The principal importance of our findings is that they can be used by anesthesiologists, specifically department heads, in their role as part of operating room committees. Such committees institute plans to revise the caseload of one or a few surgeons, and they then evaluate the results of those plans. The findings of this study are applicable to all anesthesia groups and may be especially valuable to the heads of anesthesiology departments who do not have the data to repeat our analyses. RésuméObjectif Nous avons cherche´a`savoir si les changements dans le nombre de patients ope´re´s par les chirurgiens pouvaient se refle´ter fide`lement dans les unite´s de facturation des de´partements d'anesthe´sie.

Benchmarking Surgeons’ Gender and Year of Medical School Graduation Associated With Monthly Operative Workdays for Multispecialty Groups

“…To evaluate whether our sample size of three years was adequate, we checked that the 99% CI widths for contrasts between genders were comparable to or smaller than the managerially significant difference of two workdays per month. The threshold of two workdays is important, not managerially ad hoc, because the least amount of practical surgeon block time while maintaining desired waiting times for patients is once every two weeks [ 9 , 10 ]. Similarly, to evaluate the importance of the effect size of estimated contrasts between genders, we made comparisons using Cohen’s d [ 11 ].…”

Increased Mean Time from End of Surgery to Operating Room Exit in a Historical Cohort of Cases with Prolonged Time to Extubation

“…[14][15][16] Batch means are used because the master surgical schedule influences which surgeons work on which days, and thereby causes the presence of prolonged extubations to be clustered by time of day and day of the week. 17,18 Prolonged extubations can be influenced by personnel, and their availability can depend on the numbers of simultaneous ends of cases. 2,[19][20][21][22] The effective sample size is the number of quarters (8 ≤ N ≤ 22, see preceding paragraph), not the numbers of patients or events (prolonged extubations).…”

Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home

“…38,39 There are even fewer hospitals that have many individual surgeons consistently filling an OR with at least 8 hours of cases each workday that the surgeon is doing at least one case. [113][114][115] Consequently, the potential for substantive net cost reduction is limited by the fact that although reducing OR time does make very good economic sense, this is so only when targeted to those individual surgeons with many hours of cases. It is close to meaningless to read a statement 111 that reducing OR time by 10 minutes reduces costs by $33.50 (or some even larger value), because OR time is not simply a variable cost (see Section 2).…”