Percentages of Cases in Operating Rooms of Sufficient Duration to Accommodate a 30-Minute Breast Milk Pumping Session by Anesthesia Residents or Nurse Anesthetists

Abstract

Introduction: Accommodating breast milk pumping sessions is required by US federal statute, but fulfillment is challenging for US anesthesia providers (e.g., anesthesia residents and nurse anesthetists). Considerations of good anesthesia practices (e.g., being present for critical portions of cases, including induction and emergence) create limits on which procedures are suitable for such relief. Our objective was to quantify the minimum percentages of cases for which there could reliably (≥ 95%) be at least 30 minutes during the surgical time when the anesthesia provider could receive such breaks. Methods: We studied all surgical cases performed at an anesthesia department over four years, including its inpatient surgical suite, pediatric hospital, and ambulatory surgery center. The 5% lower prediction bounds of surgical times (surgery or procedure start to end) were calculated from three years of historical data (October 1, 2016, to September 30, 2019) based on two-parameter lognormal distributions. The prediction bounds were compared to actual surgical start times during the next one year (October 1, 2019, to September 30, 2020). We considered the interval available for a breast milk pumping session during a case to be from 15 minutes after the start of the surgical time (to allow completion of initial documentation, other activities, and hand-off to the relieving anesthesia provider) until the end of the surgical time. Results: The lower prediction bounds were accurate, with 4.9% (4.6% - 5.2%) of future cases’ surgical times being briefer, matching the nominal 5.0% rate. Applying these bounds, approximately 39% of cases (99% confidence interval 39% - 40%) were reliably of sufficient duration for the anesthesia provider delivering care in that one operating room to receive a 30-minute break for breast milk pumping session between 15 minutes after the start of surgery and procedure end. This percentage (39%) was substantially less than the 72% of the surgical times that were observed, in retrospect, to be sufficiently long because the lower 5% prediction bounds accounted correctly for the uncertainty in the duration of each case. The observed 39% prevalence was significantly fewer than half the cases (P < 0.0001 vs. 50%) suitable for such relief. Conclusions: Individuals making operating room assignments for anesthesia providers need to consider the 5% lower prediction bounds of surgical times for cases in the room when making such assignments for women who require time for breast milk pumping sessions. Such considerations will generally result in assignments to rooms with one or more long-duration cases. Such a strategy may involve changes in preferred assignments for the anesthesia providers and alteration in the order of rotations for anesthesia residents (e.g., palliative care rotation rather than transition to practice at a pediatric ambulatory surgery center). When making room assignments for anesthesia providers who are breastfeeding, our results show that the 5% lo...

Feasibility of Anesthesiologists Giving Nurse Anesthetists 30-Minute Lunch Breaks and 15-Minute Morning Breaks at a University’s Facilities

“…Our university’s Institutional Review Board determined that this project [ 1 , 2 ] does not meet the regulatory definition of human subjects research because the activity was limited to the analysis of de-identified data provided for routine administrative purposes. Three facilities of one large university group practice were studied (Table 1 ).…”

“…The historical period to estimate future surgical times was three years from October 2016 through September 2019 [ 1 , 2 ]. We used every one of the 95,146 cases performed at the university’s surgical suites, with no exclusions, to predict future surgical times [ 1 , 2 ].…”

“…The historical period to estimate future surgical times was three years from October 2016 through September 2019 [ 1 , 2 ]. We used every one of the 95,146 cases performed at the university’s surgical suites, with no exclusions, to predict future surgical times [ 1 , 2 ]. A comparison was done with the cases performed in the next (future) year from October 2019 through September 2020, limited to the studied surgical suites (Table 1 ) [ 1 , 2 ].…”

“…We used every one of the 95,146 cases performed at the university’s surgical suites, with no exclusions, to predict future surgical times [ 1 , 2 ]. A comparison was done with the cases performed in the next (future) year from October 2019 through September 2020, limited to the studied surgical suites (Table 1 ) [ 1 , 2 ]. Surgical cases of the same procedure were matched between the historical three-year period and the future one-year period.…”

“…A 5% lower prediction bound for a given case gives a 5% risk of the surgical time being too brief for the break. For each procedure, the historical data provided a sample size, sample mean of logarithms of surgical times, and sample standard deviation of the logarithms of surgical times [ 1 , 2 , 4 ]. For procedures with more than 99 previous cases, the most recent 99 cases were used [ 1 - 3 ].…”