6:00 Labor Analysis 482 230 280 0.5809 150 102 14:02

The above shows information about the work of a CRNA during the day.

The CRNA clocked in at 6:00 am and out at 14:02 for total Time-on-the-Clock wage minutes of 482.

230 is the amount of time from the beginning of the CRNA’s first case, to the end of his last case.

280 is the total amount of time billed for the CRNA doing cases that day.  Obviously there’s a potential problem since there must be some overlap of time being billed for the CRNA on two or more cases.

.5809 is the ratio of time billed for the CRNA vs Time-on-the-Clock. When the prior problem of overlap billing is resolved, the ratio of billable hours to paid salary hours will be .4772 –significantly less.

150 is the amount of minutes from clocking-in until the CRNA starts his first billable case.

102 is the amount of minutes from finishing the last billable case and the CRNA clocking-out.

There’s lots of information in this simple code, along with lots of details that need to be addressed:

1. Overlap billing could spell trouble with an insurance agent, HMO, medicare…

2. Why is the CRNA clocking-in 150 minutes (2.5 hrs) before doing his first case? He might be busy, or he might not.  Can the non-billable time required for maintenance activities be accomplished during the unavoidable down time between cases?

3. Why is the CRNA clocking-out 102 minutes (1.7 hrs) after doing the last billable case? There are several reasons for this: some good, some bad, most economically bad (for whomever is paying his salary).

4. A gantt chart should also be available that helps visually with interpreting the times within the context of the entire OR schedule such as the spacing of downtime between cases.

Most often, none of this information is collected, and rarely is it ever available immediately to deal with problems during the time when it is best addressed.

As an anesthesiologist, while actually supervising the CRNAs during the day, if you were watching a list of 20 of these numbers (representing 20 CRNAs) and saw:

6:00 Bob Smith CRNA 115 0 0 0 -540 540 15:00      (15:00 is Bob’s scheduled quitting time)

…you’d explore why Bob Smith has not started any cases.  If there were 9 or 10 more CRNAs with similar numbers, you could infer that there is a systematic problem occuring: maybe a meeting, maybe most of the orderlies who get the patients called in sick, maybe you’ve greatly overstaffed (or poorly supervised) your CRNAs, equipment might be broken (the same equipment 3 days out of every five?), maybe you need to have your CRNAs clock-in an hour before their first case instead of 6:00 am since most of the cases begin at 8:00 am.  It’s still 7:55 in the morning, though–time enough to change things for today…and tomorrow.