Category Archives: anesthesiologist

of interest to anesthesiologists

MIT news: “flexibility in resources drastically improves wait times”


From MIT news (August 6, 2013)—    From theory to practice “In work beginning with his master’s thesis, Xu has shown that having even a little flexibility in resources drastically improves wait times”: I blogged about this in January 2010 … Continue reading

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Getting Dr. Able out of the OR before 4pm…


narration for SHS1013 poster presentations supports  #161 “SHS2013 Clarifying OR On Time Starts” supports #107 “SHS2013 Clarifying OR Turnover Time Concept Graph” supports #113 “Resolving Resistance to OR scheduling changes; Implementing a Multi-faceted Model” also see The effects of late surgeons … Continue reading

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OR Policy Comparative Results and PreOP Congestion


See also: “SHS2013 Resolving Resistance to OR Scheduling” “SHS2013 Clarifying OR Turnover Time Concept Graph” “SHS2013 Clarifying OR On Time Starts” Many PreOp holding areas have a large variance in their usage.  To keep PreOp from being a constraint (bottleneck) for surgery (surgeons … Continue reading

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Graphic Simulation Interactions of Constraint Theory and Lean


SHS2013  #107  “Clarifying and Using OR Turnover Time for Purpose and Advantage“ supports #161 “Clarifying the Definition, Purpose, and Effects of OR On-time Starts“ supports #113 “Resolving Resistance to OR scheduling changes; Implementing a Multi-faceted Model“ also see: predicting scheduled starts for … Continue reading

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The effects of late surgeons on other surgeons, overtime, Pre-Op, PACU, and patient waiting…


SHS2013 poster presentations supported supports #161  “Clarifying the Definition, Purpose, and Effects of OR On-time Starts“ supports #113 “Resolving Resistance to OR scheduling changes; Implementing a Multi-faceted Model“ also see  Getting Dr. Able out of the OR before 4pm… | ORTimes … Continue reading

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bad research…or bad reporting?


This is an example of the perils (morbidity, mortality, and financial) of mathematical manipulation of data by researchers in basing broad conclusions without more fully understanding the processes and externalities involved: Unnecessary anesthesia adds $1B to health spending – FierceHealthcare … Continue reading

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accounting and scheduling come together…


It took a few days (alright… quite a few days), but now my accounting software (great company-versatile software) collects accounting data in the standard cost accounting  manner, yet reports it in a Throughput Accounting or Activity-based Accounting way so that … Continue reading

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increase strategy to increase throughput: …data in context…lean in context…flipped rooms…


Why is this important? It can significantly increase total throughput and throughput as referenced by a particular agent (surgeon, anesthesiologist, hospital). Increased throughput can be converted into large increases in revenue. It can decrease cost for all agents. It can … Continue reading

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the art of flipping rooms…


– There are two main parts to flipping rooms: intra-case and inter-case. They are complementary and work together iteratively. – An analogy of this iterative type of scheduling –adjusting individual cases(intra-case) and schedule (inter-case) to make a good fit– is … Continue reading

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a little data goes a long ways…


Although the expression –‘it’s not what you have, but how you use it’– is not entirely true, knowing how to massage whatever data you have can be very productive.  The data needed for this display is easily available from the … Continue reading

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FTE, utilization, and cost accounting … when PUNs equal CUEs


also see: Graph of CRNA usage for optimized Surgeon Schedule also see: TA(throughput accounting) and TDABC (time driven activity based costing)….the fabric, the ‘warp and woof’ of healthcare — Cost accounting (whether standard costing or TDABC) is based on the concept … Continue reading

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not your father’s OR scheduler…


Want to know who’s doing what, when: With what?  What’s starting when? Who’s got to be there? How many whos? Can you let a few people off early?  Can you start a few people late?  How many people need to … Continue reading

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labor analysis of CRNA from collectible time data…


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 … Continue reading

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‘risk vs return’ or ‘when the shit hits the fan’ in the OR


Taken from a Linkedin post of mine with the HFMA group: Sandra, The ‘general’ rule is that ASA 1-3 is ok for free standing facilities. That rule is effectively bent for rational reasons.  The ASA classification has a lot of … Continue reading

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OR scheduling concept map (concept diagram)…


A few years ago I diagrammed several concepts involved in scheduling an OR onto this graph.  The intent was to take advantage (or nullify disadvantages) of characteristics of individual surgeons and anesthetists. The interplay of these concepts and individual factors … Continue reading

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getting your hands dirty…


Sometimes, to get what you want, you have to jump in and get your hands dirty… It’s been a month since my last post, a series of posts dealing with ‘what ifs’ and some simple simulations dealing with scheduling OR … Continue reading

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putting it all together…intra-case and inter-case….TOT and more


There are a thousand variations of the following examples, but I hope these four graphs will get across some ideas.  For potential economic effects, see:  Wasting $2.7 million dollars a year. Each of the following graphs has 5 bars. Each … Continue reading

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absolute loss of time…


In medicine, almost nothing is absolute.  Absolutes are strictly enforced, unless the person who decided that it was  an absolute changes his mind.  In the narrow world of OR throughput, this is an important factor why surgeons (and anesthesiologists) should … Continue reading

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clinical resolution of systems engineering scheduling in the OR…


No new graphs today…  Let’s discuss the resolution of a systems engineer in improving turnover time (TOT). In the last few blogs I showed the difference in TOT due solely to who sees the patient in the pre-op holding area, … Continue reading

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coffee and donuts…. time for a break


Oh what fun…       This is just one of many factors affecting turnover time  (TOT). For the sake of  smaller graphs and clarity, I’m showing only the times till anesthesia induces the patient to show the comparison of … Continue reading

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difficulties with start times and TOT in the OR…


The following are excerpts from a discussion concerning Turn-Around-Time (TOT) in the OR.  They relate to my recent posts on scheduling, and show the complexity/difficulty in defining the problems and solving them: ____ she: There are benchmarks out in the … Continue reading

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constraints, risk, and ego in OR start delays… simple example


First off, there must be a 100 different reasons for late OR starts.  Everything from surgeons, anesthesiologist, nurses, equipment, meetings, policies, traffic, school age children and equipment…to a mix of any of the above.  The trick is in understanding the … Continue reading

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predicting scheduled starts for surgery…


also see: Graphic Simulation Interactions of Constraint Theory and Lean This is getting to be fun.  Now, for a bit of applied constraint theory… In this simulation we’re considering the surgeon as the most important person…the constraint.  We don’t want … Continue reading

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micro real options in the OR…


One advantage of performing virtually identical cases—such as specialty ORs (cataract surgery would be an example) is that the room setup is virtually identical and a great deal of time can be saved (or avoided) by being able to put … Continue reading

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TOC in the OR visualized…


Ah….  theory of constraints… This is a visual representation to help with handling constraints in the OR.  For those who use TOC, be aware that the person represented by the green bar (‘Anes MD presence’) could be simultaneously supervising four … Continue reading

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butterflies and nails…


Below is a graph of durations in the scheduling and process of just the in-room surgical parts of a typical OR case.  Most of the items can be altered by policy and by the conscious effort of the people involved … Continue reading

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Big Bwana and little bwana…


Everything in the below graph is adjustable (and is derived from less data than is normally collected in an OR). It’s quite useful when deciding how to create your portfolio of surgeons, anesthesiologists, or nurses to limit the short-comings, and … Continue reading

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divide and concur….


Once you visually see the requirements for anesthesia presence during a case, you can also see the potential for saving down-time and better utilizing particular skills when personnel are scarce.   I did leave out the pre-op visit in this … Continue reading

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the cost of late surgeons… and the revenue from early surgeons


The purple bars represent the time saved for nursing staff and anesthesia if there is a policy for the surgeon to be ready to cut 30 minutes (adjustable) before the scheduled start of cases in the morning.  The effects of … Continue reading

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Typical OR case dissected with details…


These are the relevant milestones and intervals in a typical OR case.  I left off the details so as not to detract from the comparison to the normal representation of an OR case as a single block of time with … Continue reading

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So much data…so little time


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Visual analytics for an OR case…


Visual analytics for an OR case:  Lots of information if you understand the code….   You can tell whether surgery, anesthesia, or the hospital personnel are on top of things and you can compare differences in techniques with resulting effects … Continue reading

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sample requirements for vice-chair of anesthesia department…


Below is a copy of a letter I sent for a position as vice-chair of anesthesia at a large teaching hospital.  I’ve long thought that most vice-chairmen needed to expand their skill sets. . Dear Dr. —-, As you proceed … Continue reading

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new scheduler…timeline and map integration


Operating rooms are expensive assets; you don’t want them sitting idle when people need them. Each room may be equipped differently; you want to schedule procedures in the most appropriate room. To complicate matters, some procedures require special equipment that … Continue reading

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non-expert decison making: perils of democracy…


When making an individual decision, or whether voting as a group, the ‘strength’ of one’s conviction on a topic should be modified by one’s expertise before coming to a final resolution.  All decisions have pros and cons, all of different … Continue reading

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new OR scheduler…


I’ve been experimenting with a new scheduler.  There are many options for visually representing information about OR cases. The scheduler is easily adapted for collecting data to analyze later. The scheduler also has a map view that can include even … Continue reading

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sample new OR scheduler


For all those OR schedulers out there, here’s a new approach.  I left most of the data off on purpose to emphasize the information that the graphics—lines, blocks, fonts, colors, sizes, and proximity— can show.  When in the program, pages … Continue reading

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hold the mayo…


Unfortunately, I forgot to take a picture of my poster presentation at the Mayo Clinic’s 3rd Annual Healthcare Systems Engineering meeting. However, I did take a picture as I was putting it together the week before.  Here it is, in … Continue reading

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business interest…


When we started this blog, we didn’t know how well it would be received.  Even though there were few comments, we could follow how many viewers had dropped by to have a look and download our graphs and articles.  We … Continue reading

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Protected: theory, tools, and techniques… abstract


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understanding visual analytics… and others


What’s wrong with this picture; I see what you mean; I hear where you’re coming from; Something doesn’t feel right: These statements represent analytics. Analytics can be defined as the presentation of input in such a way that it taps … Continue reading

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the law of unintended consequences…staffing anesthesiologists


Value: easily and potentially > than $1,000,000 a year Let’s suppose that a hospital wants fellowship trained anesthesiologists to do all their cases: pediatric anesthesia fellowship for all pediatric cases, neuroanesthesia fellowship for all neuro cases, ob-gyn fellowship for all … Continue reading

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OR throughput, flipping rooms with fast and slow anesthesia…


I found some graphs that I put together a couple of years ago.   The results are born out empirically (at least by my experience in the OR). Lots of information about who to hire, who to fire, who to … Continue reading

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only the beginning…


In my last year of anesthesia residency, an attending told the graduating class “You’re just beginning.  We hope we’ve taught you enough so that you won’t kill anyone.” A surgical friend of mine said that he was very good technically … Continue reading

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Disruptive behavior… zero tolerance by Joint Commission; Is your hospital in compliance?


Physician and nurse executives team up to fight disruptive behavior The American College of Physician Executives and the American Organization of Nurse Executives are joining forces to stamp out disruptive behavior. The two organizations are providing resources and guidance to … Continue reading

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mathematician, technician, or healthcare professional…


There are different tools for evaluating what has been done and what should be done.  Confuse the two at your own risk. The finance industry caused significant damage to the world economy because they confused the two.  Given any set … Continue reading

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Let sleeping children lie…


While I was at KFSH&RC in Saudi Arabia, a Kiwi friend of mine who was head of the radiation oncology department asked me if my department (anesthesia) could help them expedite their pediatric radiation treatments.  It would take them all … Continue reading

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How to Tell the Productive Surgeons from the non-Productive


The previous blogs were concerned with economic gains for the different parties (surgeon, anesthesia, hospital) by optimizing the relationship each case had with another case (inter-case) — the OR schedule.  Each OR is dramatically different, and what works for one … Continue reading

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communication…life line


With today’s technologies, there are multiple ways for anesthesiologists and surgeons to keep organized and transfer documents while driving in the city, roaming the halls of the hospital, or during a case in the OR.  No one should have to … Continue reading

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Protected: the fungible anesthetist…


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incentive, compensation, transparency


Incentive, Competitiveness, Transparency If most of anesthesiologists are supervising CRNAs, the anesthesiologists’ job is to increase the amount of the CRNAs’ billable time at the facility. Have the anesthesiologists do all the pre-ops, IVs in the pre-op area, and care … Continue reading

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Same as last post. CRNA centric view of schedule for the day.


Here’s a different view of CRNA usage (bottom graph of last post –January 23, 2010).  It’s organized by CRNA—Follow the CRNA through the day to successive rooms. The CRNA (1aa, 1ab, 1af…) is listed to the right of every horizontal … Continue reading

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The bottom line…


Each row represents an individual CRNA.  If over half of each time unit (10 minutes) is billable on an anesthesia record, then it is red.  Less than half is yellow. Exactly half is green. Lines that are all yellow belong … Continue reading

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Can I trust my state medicaid and medicare system?


Missouri, one of only 3 states to receive an “A” in management information by Governing Magazine in 2008 is highlighted in the following article.  If Missouri is in the top 3, how can we trust the rest?  Best to have … Continue reading

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Graph of CRNA usage for optimized Surgeon Schedule


also see: FTE vs cost accounting … when PUNs equal CUEs also see: Wasting surgeons’ time This is a graph of the CRNA usage for the Optimized Surgeon schedule from the blog post dated Jan 20, 2010.   Compare this graph to … Continue reading

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Graphs of Actual and Optimized Surgical Schedule


Warning! Not for the graphically challenged. In reference to the graphs I posted on January 14, 2010, I’ve added several graphs with detailed information. The first graph is of the actual room schedule (non-optimized) before optimizing it by a better … Continue reading

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Who’s in charge here, anyway?


A big problem in the OR is that not everyone is working for the same goal.  The major players are surgeons, anesthesiologists, and the hospital (nurses, orderlies, administrators, etc.), each wanting to maximize their income and minimize their work and … Continue reading

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With whom should I do my cases?


<click on the above graph for a larger image> The above graph is an example of finished data analysis for three different orthopedic groups (Arizona Cutters, ORO Pods, Tucson Bones) which are deciding in which hospital, and with which anesthesia … Continue reading

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Do you know where your CRNAs are?


<click on graph to enlarge in separate window>  [Note that the scale for the upper and lower graphs are different] I mentioned in the prior post that my client had wanted an analysis of how well they were using their … Continue reading

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Wasting surgeons’ time? One hospital– $27 Million opportunity Loss per Year from scheduling


click here:  3 Graphs of Actual and Optimized Surgical Schedule « ORTimes – Healthcare Systems Engineering Analysis The above chart was derived from data from a client who wanted to know if they were using their CRNAs efficiently. (we’ll show that … Continue reading

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