The July Spike in Operating Room Management: Reality or Perception?

摘要

Background?Some research has found increased incidence of medical errors in teaching hospitals at the beginning of the academic year and have termed this the “July Phenomenon.”;Objective?Our primary hypothesis was that the “July Phenomenon” for anesthesiology and surgical residents might manifest itself as operational inefficiency, measured by monthly total operating room (OR) minutes. Secondary measures were monthly elective overutilized minutes (OR workload minus OR allocated time, after 5:30 pm at our institution), 80th percentile number of ORs running at 7:00 pm, and mean last room end time.;Methods?Data were collected retrospectively from a 525-bed academic tertiary care hospital from January 2010 to September 2014 and were deconstructed to assess for a seasonal component using local regression (Loess). Variable month length was addressed by transforming the monthly totals to average daily minutes and overutilized minutes. Linear regression quantified significance for all primary and secondary analyses.;Results?In the regressions, monthly average minutes showed no significant difference in July (P?=?.65) compared to the baseline month of April. There were no significant differences for any month for overutilized minutes or 80th percentile number ORs working at 7:00 pm. Only August was significant (P?=?.005) for mean last room end time.;Conclusions?Data from a single institution study did not show a “July Phenomenon” in the number of operating minutes, overutilized minutes, or the number of ORs working late in July.;Introduction For 2 decades, authors have commented on a perceived increase in medical complications and errors at the beginning of the academic year and across a variety of specialties and have sought to validate this “July Phenomenon” in hospitals with residency programs.1–6 For academic anesthesiology departments, this may not be surprising, because anesthesiology requires a technical skill set in a high-pressure environment, in which individuals directly administer medications to patients. Given the specialty's opportunities for single points of failure (eg, medication error, procedural complication), anesthesiology residencies may incur operational inefficiencies as a result of allocating additional activities necessary to prevent or mitigate error.7 At the University of Vermont Medical Center, July is when anesthesiology residents begin their specialty training, and it also is a transition time for our surgical trainees. We hypothesized that the acclimatization process for anesthesiology and surgical residents to both the clinical skill sets and daily operational aspects of the operating room (OR) results in increased operative time, overutilized time (actual surgical workload minus allocated block time), the average number of sites running past the end of the scheduled day, and the completion time of the last OR.;Methods All data were collected retrospectively between January 2010 and September 2014 from the University of Vermont Medical Center, a 525-bed academic hospital and tertiary care center. The Department of Anesthesiology maintains an automated OR electronic health record, Picis (Picis Clinical Solutions Inc, Wakefield, MA). Statistical analysis was done using R version 3.1.1 (The R Foundation) and RStudio version 0.98.1049 (RStudio, Boston, MA). We used WiseOR (WiseOR Inc, Palo Alto, CA) to extract the following data: total monthly OR minutes (all cases over all days), total overutilized minutes for elective cases, monthly 80th percentile of the number of rooms staffed at 7:00 pm, and the monthly mean end time for the last case. The OR suite has 19 sites scheduled to begin at 7:30 am, Monday through Friday. Overutilized time is defined as the actual surgical workload minus the allocated block time in minutes. At the University of Vermont Medical Center, 5:30 pm is defined as the end of block time and the beginning of overutilized time. For the staffing analysis, we arbitrarily chose 7:00 pm in a