Abstract ID: A29

Abstract Title: The Introduction of a Regional Anesthesia Rotation: Effect on Operating Room Efficiency and Resident Education

Poster Type: Discussion


ABSTRACT BODY

Introduction:
Although the overall effect of intraoperative regional anesthesia (RA) on operating room times is controversial, use of intraoperative RA is associated with an improvement in operating room (OR) efficiency as assessed by a reduction in “anesthesia-controlled times” in some studies [1,2]. Optimizing OR efficiency in these trials typically involves using additional anesthesia personnel to facilitate administering RA in a holding area for a subsequent case while the first case is still in the room (“parallel processing”) rather than administering RA in the OR room only after completion of the previous case and operating room turnover (“serial processing”).
In an academic setting, the incorporation of a “parallel” rather than “serial” processing of the administration of RA as part of a RA rotation may also improve resident education by increasing the number of peripheral nerve blocks performed, concentrating the experience of learning to perform various nerve blocks, and allowing for increased time for teaching of nerve blocks. Increasing the number of peripheral nerve blocks is important for many academic institutions as the ACGME has mandated a minimal number of peripheral blocks each anesthesiology resident will need to perform prior to the completion of his/her residency. We describe the creation of a regional anesthesia rotation during a transition from a “serial” to “parallel” processing of administering nerve blocks and its effect on resident education and OR room efficiency.

Materials and Methods:
All shoulder and total hip/knee arthroplasty procedures, each performed by a single surgeon and performed under RA, were retrieved from an OR database which was created from patient billing and anesthesia record data. For each procedure, the following times were obtained: total OR (patient in -out of room), total surgery (surgery start-finish), total anesthesia (anesthesia start-finish), anesthesia prep (patient in room-anesthesia ready), and turnover time (patient out room from previous case to patient in room to the following case). A comparison was made between a 6-month period prior to (7/1-12/30/1999) to a 6-month period (1/2/2001-6/30/2001) after opening of the new operating room suite during which time our RA rotation was started (9/2000). Prior to this date, there was no organized RA rotation and RA was performed as a serial process whereas the new RA rotation allowed for a parallel processing of RA. In addition, the number of peripheral nerve blocks by anesthesia class was recorded.

Results:
The OR times for shoulder and total hip/knee arthroplasty procedures are shown in Tables 1 and 2, respectively. For total hip/knee arthroplasty, there were no differences between the groups; however, for the higher volume shoulder procedures, there was a significant decrease in total OR, anesthesia prep and turnover times for cases performed after introduction of the RA rotation. The number of peripheral but not neuraxial nerve blocks performed per resident increased after introduction of the RA rotation (Table 3).

Discussion:
1. Williams BA, et al. Anesthesiology 2002;97:981-8.
2. Williams BA, et al. Anesthesiology 2000;93:529-38.
3. Dexter F. Reg Anes Pain Med 1998;23:439-43.

ATTACHED FILES

A29_table1.doc

A29_table2.doc

A29_table3.doc

Reg Anesth Pain Med 2004; 29(2):A29