Abstract
The objective of this study was to characterize workload during all hours of the day in the non-operating room anesthesia (NORA) environment and identify what type of patients and procedures were more likely to occur during after-hours. By investigating data from the National Anesthesia Clinical Outcomes Registry, we characterized the total number of ongoing NORA cases per hour of the day (0 – 23 h). Results were presented as the mean hour and standard error (SE). Multivariable logistic regression was applied to assess the association of various patient, procedural, and facility characteristics with time of day (after-hours = 17:01–06:59 local time versus day-time). Included in this analysis, there were a total of 4,948,634 cases performed on non-holiday weekdays. The mean hour for ongoing cases for gastroenterology, cardiac, radiology and “other” were: 10.8 with standard error (SE) of 0.002, 11.5 (SE of 0.005), 11.2 (SE of 0.005), and 10.8 (SE of 0.002), respectively. Pairwise differences between means for each NORA specialty were all statistically significant (p < 0.0001). During after-hour shifts (4.3% of cases), patients with higher American Society of Anesthesiologists physical status classification scores had increased odds for undergoing a NORA procedure, while procedures that were more physiologically complex had decreased odds. With the increasing demand for NORA services, it is prudent that we fully understand the challenges of providing safe and efficient anesthetic services particularly in locations where fewer resources are available.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Chang, B., and Urman, R.D., Non-operating room anesthesia: The principles of patient assessment and preparation. Anesthesiol. Clin. 34(1):223, 2016.
Chang, B., Kaye, A.D., Diaz, J.H., Westlake, B., Dutton, R.P., and Urman, R.D. Complications of non-operating room procedures: outcomes from the national anesthesia clinical outcomes registry. J. Patient Saf. 2015. http://dx.doi.org/10.1097/PTS.0000000000000156.
Nagrebetsky, A., Gabriel, R.A., Dutton, R.P., and Urman R.D. Growth of nonoperating room anesthesia Care in the United States: A contemporary trends analysis. Anesth. Analg. 124(4):1261–1267, 2017.
Bell, C., and Sequeira, P.M., Nonoperating room anesthesia for children. Curr. Opin. Anaesthesiol. 18(3):271, 2005.
Bhavani, S., Non-operating room anesthesia in the endoscopy unit. Gastrointest. Endosc. Clin. N. Am. 26(3):471, 2016.
Dutton, R.P., Making a difference: The anesthesia quality institute. Anesth. Analg. 120(3):507, 2015.
Wachtel, R.E., and Dexter, F., Differentiating among hospitals performing physiologically complex operative procedures in the elderly. Anesthesiology. 100(6):1552, 2004.
Dexter, F., Epstein, R.H., Campos, J., and Dutton, R.P., US National Anesthesia Workload on Saturday and Sunday mornings. Anesth. Analg. 123(5):1297, 2016.
Dexter, F., Dutton, R.P., Kordylewski, H., and Epstein, R.H., Anesthesia workload nationally during regular workdays and weekends. Anesth. Analg. 121(6):2015, 1600.
Dalton, M.K., McDonald, E., Bhatia, P., Davis, K.A., and Schuster, K.M., Outcomes of acute care surgical cases performed at night. Am. J. Surg. 212(5):831, 2016.
Turrentine, F.E., Wang, H., Young, J.S., and Calland, J.F., What is the safety of nonemergent operative procedures performed at night? A study of 10,426 operations at an academic tertiary care hospital using the American College of Surgeons national surgical quality program improvement database. J. Trauma. 69(2):313, 2010.
van Zaane, B., van Klei, W.A., Buhre, W.F., Bauer, P., Boerma, E.C., Hoeft, A., Metnitz, P., Moreno, R.P., Pearse, R., Pelosi, P., Sander, M., Vallet, B., Pettila, V., Vincent, J.L., and Rhodes, A., European surgical outcomes study group for the trials groups of the European Society of Intensive Care M, the European society of a. Nonelective surgery at night and in-hospital mortality: Prospective observational data from the European Surgical Outcomes Study. Eur. J. Anaesthesiol. 32(7):477, 2015.
Abouleish, A., and Evenson, T.B., The fallacy of the field of dreams business plan. ASA Newsl. 71(12):30, 2007.
Tsai, M.H., Huynh, T.T., Breidenstein, M.W., O'Donnell, S.E., Ehrenfeld, J.M., and Urman, R.D., A system-wide approach to physician efficiency and utilization rates for non-operating room anesthesia sites. J. Med. Syst. 41(7):112, 2017.
Goudra, B., Alvarez, A., and Singh, P.M., Practical considerations in the development of a nonoperating room anesthesia practice. Curr. Opin. Anaesthesiol. 29(4):526, 2016.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
Funding support from National Library of Medicine (NLM) training grant number T15LM011271.
Conflict of Interest
Rodney A. Gabriel declares that he has no conflict of interest; Brittany N. Burton declares that he has no conflict of interest; Mitchell H. Tsai declares that he has no conflict of interest; Jesse M. Ehrenfeld declares that he has no conflict of interest; Richard P. Dutton declares that he has no conflict of interest; Richard D. Urman declares that he has no conflict of interest. Drs. Urman and Dutton serve as Data Use Committee Members, Anesthesia Quality Institute.
Ethical Approval
IRB approval was obtained. However, this article does not contain any studies with human participants performed by any of the authors.
Disclaimers
none.
Additional information
This article is part of the Topical Collection on Systems-Level Quality Improvement
Rights and permissions
About this article
Cite this article
Gabriel, R.A., Burton, B.N., Tsai, M.H. et al. After-hour Versus Daytime Shifts in Non-Operating Room Anesthesia Environments: National Distribution of Case Volume, Patient Characteristics, and Procedures. J Med Syst 41, 140 (2017). https://doi.org/10.1007/s10916-017-0793-5
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s10916-017-0793-5