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ECONOMICS, EDUCATION, AND POLICY

A Simulation Model for Determining the Optimal Size of Emergency Teams on Call in the Operating Room at Night

Jeroen M. van Oostrum, MSc^*, Mark Van Houdenhoven, PhD^*, Manon M. J. Vrielink, MSc^*, Jan Klein, MD, PhD, Erwin W. Hans, PhD, Markus Klimek, MD, DEAA, Gerhard Wullink, PhD^*, Ewout W. Steyerberg, PhD, and Geert Kazemier, MD, PhD^*||

From the Departments of *Operating Rooms; Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Operational Methods for Production and Logistics, School of Business, Public Administration and Technology, University of Twente, The Netherlands; Departments of Public Health; and ||Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.

Address correspondence and reprint requests to Jeroen van Oostrum, Department of Operating Rooms, Erasmus University Medical Center, Room NH-4A, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Address e-mail to j.vanoostrum{at}erasmusmc.nl.

Abstract

BACKGROUND: Hospitals that perform emergency surgery during the night (e.g., from 11:00 pm to 7:30 am) face decisions on optimal operating room (OR) staffing. Emergency patients need to be operated on within a predefined safety window to decrease morbidity and improve their chances of full recovery. We developed a process to determine the optimal OR team composition during the night, such that staffing costs are minimized, while providing adequate resources to start surgery within the safety interval.

METHODS: A discrete event simulation in combination with modeling of safety intervals was applied. Emergency surgery was allowed to be postponed safely. The model was tested using data from the main OR of Erasmus University Medical Center (Erasmus MC). Two outcome measures were calculated: violation of safety intervals and frequency with which OR and anesthesia nurses were called in from home. We used the following input data from Erasmus MC to estimate distributions of all relevant parameters in our model: arrival times of emergency patients, durations of surgical cases, length of stay in the postanesthesia care unit, and transportation times. In addition, surgeons and OR staff of Erasmus MC specified safety intervals.

RESULTS: Reducing in-house team members from 9 to 5 increased the fraction of patients treated too late by 2.5% as compared to the baseline scenario. Substantially more OR and anesthesia nurses were called in from home when needed.

CONCLUSION: The use of safety intervals benefits OR management during nights. Modeling of safety intervals substantially influences the number of emergency patients treated on time. Our case study showed that by modeling safety intervals and applying computer simulation, an OR can reduce its staff on call without jeopardizing patient safety.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999