Should anesthesia groups advocate funding of clinics and scheduling systems to increase operating room workload?

摘要

BACKGROUND: Knowledge of patterns related to patient visits in a multispecialty group is important for helping anesthesia groups make strategic and tactical decisions relevant to increasing anesthesia workload. METHODS: The authors studied surgery at an outpatient surgery center over 6 months and analyzed every clinic visit that preceded surgery by 2 yr. They also studied surgery that occurred at either the outpatient center or a tertiary surgical suite over 3 months, including all preceding clinic visits. RESULTS: Results were similar whether data were analyzed by number of cases or by American Society of Anesthesiologists' Relative Value Guide units. The median number of visits to the surgeon before surgery was 2 (95% confidence interval 2-2). Most patients have one visit with the surgeon, decide to have surgery, and then have one preoperative visit. Fewer than 20% of American Society of Anesthesiologists' Relative Value Guide units for outpatient surgery arose from patients seen by a primary care or nonsurgical specialist before referral to the surgeon. Patients with more than one previous surgery at the facility accounted for less than 6% of American Society of Anesthesiologists' Relative Value Guide units. CONCLUSION: Investment in outpatient primary care clinics, nonsurgical specialty clinics, or scheduling systems to facilitate patient appointments would not materially affect anesthesia workload. The workload of the anesthesia department depends on facilitating surgeon-dependent processes: (1) open access to operating room time on any future workday, (2) well-calculated blocks to permit high surgeon productivity, and (3) open access to surgeon clinics to reduce days from referral to first appointment.