Optimizing second shift OR staffing - operating room staffing

AORN Journal,  April, 2003  by Franklin Dexter,  Richard H. Epstein

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In most health care facilities, ORs still are being used for procedures during the late afternoon. Nurse anesthetists, perioperative nurses, and other staff members may be scheduled to work a second shift (eg, 3 to 11 PM) to cover these procedures. If too many staff members are planned for procedures performed outside of regularly scheduled hours, their time will be underused. If second-shift staffing is too low, however, first-shift staff members will need to stay late to cover the extra OR time. Both alternatives lead to extra staff member costs, but there are ways to ensure that staff members are not being paid excessive amounts of overtime or for time when they are not needed.

The need for nurse anesthetists and perioperative nurses can differ during the second shift, which may reflect differences in work hour preferences, contractual rules, frequency of procedures using local anesthesia, and workload. For example, nurse anesthetists' workloads in the OR during afternoons may exceed those of perioperative nurses. After a procedure ends, the nurse anesthetist must transport and stabilize the patient in the postanesthesia care unit (PACU) or intensive care unit (ICU). In addition, procedures that end in the late afternoon often are complex and may have been running all day. Transferring care to PACU or ICU nurses can take an hour or more, as a variety of duties may be necessary (eg, checking arterial blood gases while adjusting ventilator settings).

This article considers whether optimal nurse anesthetist second-shift staffing in the OR differs from optimal perioperative nurse second-shift staffing. This question is important to managers considering the expense of software that connects an anesthesia billing database or an OR information system database to staffing decision support software. At many health care facilities, the anesthesia billing system and OR information system are different systems. If both are needed to make staffing calculations, hospital information systems personnel will have to do twice as much work to provide staffing data.

Data could be expected to show that, during the second shift, nurse anesthetists' workloads in the OR recorded using an anesthesia billing system are greater than perioperative nurses' workloads recorded using an OR information system. Despite this systematic difference, the authors of this study expected that optimal nurse anesthetist second-shift staffing in the OR calculated using anesthesia times would be the same as optimal perioperative nurse second-shift staffing calculated using OR times. This result would mean that perioperative managers would need to use only one database to plan staffing needs, saving time and expense. Such a result also would mean that at hospitals without OR information systems data, perioperative nursing and nurse anesthetist second-shift OR staffing decisions could be made using anesthesia billing data.

THE APPROACH

To determine whether optimal nurse anesthetist second-shift staffing and perioperative nurse staffing times calculated using the different software systems were the same, procedure start and stop times were collected. Dates and times for each patient's entrance into and exit from the OR were the data used from the OR information system. These times determined the maximum number of ORs where a procedure was being performed at any time during each one-hour period between 3 and 11 PM. (1) The dates and times of the start and end of continuous anesthesia care were the data used from the anesthesia billing system. These times determined the simultaneous anesthetics any time during each one-hour period between 3 and 11 PM. (2) For example, in a surgical suite with two ORs, if a procedure was finished in OR I at 3:15 PM and a procedure was started in OR II at 3:30 PM, the maximum number of ORs running from 3 to 3:59 PM is two.

The goal of the second-shift staffing method is to find a staffing solution that minimizes labor costs during the second shift. Labor costs can be calculated in units of regularly staffed hours. The labor cost for one hour during the second shift equals the sum of two terms, where the first term is the number of nurse anesthetist or perioperative nurse teams working during regularly staffed hours, and the second term equals the number of nurse anesthetists or perioperative nurse teams working late (ie, during overused OR time) during that hour multiplied by the relative cost of one overused hour to a regular hour. (3) A commonly used value for this relative cost is 1.75. (4) This includes the direct costs of overtime or bonuses at time and one-half (ie, 1.5) and an increment (ie, 0.25) for indirect costs from employee dissatisfaction or resignation and recruitment and training costs. (5) For example, if a nurse anesthetist was scheduled to work eight hours from 7 AM to 3 PM and then stayed on call until 5:45 PM, the second-shift labor cost is considered to equal the cost of 3.5 regularly staffed hours, where 3.5 = 1.75 multiplied by two hours with at least one anesthetic.