Cohort study of cases with prolonged tracheal extubation times to examine the relationship with duration of workday
Cohort study of cases with prolonged tracheal extubation times to examine the relationship with duration of workday
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DOI：
10.1007/s12630-013-0025-5
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发表时间：
2013-11-01
影响因子：
4.2
通讯作者：
Brull, Sorin J.
中科院分区：
文献类型：
--
作者：
Epstein, Richard H.;Dexter, Franklin;Brull, Sorin J.
通过减少手术室 (OR) 时间而产生效益的麻醉药物或装置的使用的经济性取决于一周中的哪一天以及手术室中进行手术的总小时数。这主要与医院内部和医院之间手术室定期安排的工作日的不同持续时间有关。我们测试了与避免延长气管拔管时间的经济效益相关的假设。观察数据来自一家使用麻醉信息管理系统的多专业学术三级医院。气管拔管时间延长被认为是手术结束后15分钟或更长时间拔管。对延长气管拔管时间的评估仅限于患者在手术室期间进行气管插管和拔管的情况。计算 n = 39 个四周周期中每个周期的百分比。结果以这些百分比的平均值（平均值的标准误差）形式报告，短语“最多/至少”用于指代相应的 95% 置信限。 气管拔管时间延长的最多 6.1% [平均值 5.5 (0.3)%] 可归因于在常规工作日上午 7:00 至晚上 10:59 期间未结束的病例。至少 55.6% 的气管拔管时间延长发生在正常工作日的病例以及病例和周转时间超过 8 小时的手术室中 [平均 57.0 (0.9)%； P<0.0001]。该百分比比所有其他情况大 23.8 (0.8)%。在缺乏准确的设施特定成本分析的情况下，延长气管拔管时间不应被视为固定成本，而应视为导致按比例增加或可变成本。
The economics of the use of an anesthetic drug or device that produces benefit through reduction in operating room (OR) time depends on the day of the week and the total hours of surgical cases in the OR in which they are performed. Principally, this has to do with different durations of the regularly scheduled workday in the ORs within and among hospitals. We tested hypotheses relevant to the economic benefit of avoiding prolonged tracheal extubation times.Observational data were obtained from a multiple-specialty academic tertiary hospital that uses an anesthesia information management system. Prolonged tracheal extubation times were considered those with tracheal extubations occurring 15 min or more after the end of surgery. The assessment of prolonged tracheal extubation times was limited to cases for which the patient's trachea was intubated and extubated while physically in the OR. Percentages were calculated for each of n = 39 four-week periods. Results are reported as mean (standard error of the mean) of these percentages, and the phrases "at most/least" are used to refer to the corresponding 95% confidence limits.At most, 6.1% [mean 5.5 (0.3)%] of the prolonged tracheal extubation times were attributable to cases that did not end during regular workdays from 7:00 AM-10:59 PM. At least 55.6% of prolonged tracheal extubation times occurred during cases on regular workdays and in an OR with more than eight hours of cases and turnovers [mean 57.0 (0.9)%; P < 0.0001]. This percentage was 23.8 (0.8)% larger than for all other cases.In the absence of an accurate facility-specific cost analysis, prolonged tracheal extubation times should not be treated as fixed costs but as resulting in proportionally increased OR variable costs.