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ECONOMICS, EDUCATION, AND POLICY

Task Analysis of the Preincision Period in a Pediatric Operating Suite: An Independent Observer-Based Study of 656 Cases

Haleh Saadat, MD^*, Alejandro Escobar, MD^*, Elizabeth A. Davis, RDCS^*, Jan Ehrenwerth, MD^*, Gail Watrous, RN^*, Gene S. Fisch, PhD, Zeev N. Kain, MD, MBA^*, and Paul G. Barash, MD^*

From the *Department of Anesthesiology, General Clinical Research Center, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut.

Address correspondence and reprint requests to Paul G. Barash, MD, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT 06520-8051. Address e-mail to paul.barash{at}yale.edu.

Abstract

We designed this cross-sectional investigation to assess anesthesia release time (ART = patient-on-table until release for surgical preparation) and surgical preparation time (start of surgical preparation to incision) of children undergoing anesthesia and surgery (n = 656). Data collected by trained independent observers included variables such as age, ASA physical status, anesthetic technique, and placement of invasive monitoring. We found that mean ART was 11.0 ± 9.7 min and the mean surgical preparation time was 11.1 ± 10.0 min. Also, ART ranged from 7 ± 7 min (for mask anesthesia) to 52 ± 18 min (general anesthesia/endotracheal tube and invasive hemodynamic monitoring). The percentage of ART of the total case length was 15% ± 7%, with a wide variability depending on the total case length. We also found that there is a significant variability in ART as a function of the surgical service involved (analysis of variance; P = 0.0001), ASA physical status (P = 0.0001), and age. For example, younger children had a significantly longer ART as compared with older children (P = 0.001). Room coverage ratio by the attending anesthesiologist and training level of the anesthesia resident did not impact ART (P = not significant). We conclude that ART in children undergoing surgery is highly variable and is a function of factors such as the surgical service involved, age of the child, and ASA physical status of the child. These factors should be considered when scheduling a surgical case.

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