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Benchmarking Anesthesia-Controlled Times at a Tertiary General Hospital in the Philippines
Patricia Lorna O. Cruz,1 Emmanuel S. Prudente2 and Marie Carmela M. Lapitan3,4,5
1Department of Anesthesiology, College of Medicine and
Philippine General Hospital University of the Philippines Manila
2Department of Anesthesiology, Corazon Locsin Montelibano Memorial Regional Hospital
3Department of Surgery, Philippine General Hospital, University of the Philippines Manila
4Institute of Clinical Epidemiology, National Institutes of Health,
University of the Philippines Manila
5Department of Surgery, Uniformed Services University of the Health Sciences, Maryland, USA
The need to measure and improve quality in the health care management setting necessitates the development of performance standards. The drive for operating room (OR) efficiency has led administrators to investigate the anesthesia-controlled times (ACTs), which are the specific periods of anesthesia task completion including preparation for anesthetic induction, anesthetic induction itself, and the wake up time or time to emergence from anesthesia.
Objectives. This study aims to conduct an internal benchmarking of ACTs using a secondary analysis of the data collected in a cross sectional survey of randomly selected elective surgical cases from October 2011 to January 2012, looking into the efficiency status of the operating room under the Department of Surgery of the Philippine General Hospital (PGH).
Methods. Mean observed times for each of the milestone comprising the ACT were calculated, taking in consideration the various anesthetic techniques, type of surgical procedures, duration of the operation and the anesthesiologist's experience. Analysis of variance and Fisher's exact test were used to determine the association of these factors with the length of the ACT. For those where an association was noted, a multivariate analysis was done to determine its impact on the actual ACT.
Results. Based on data 539 cases, a set of benchmarks for ACT that better reflects the local setting, is proposed for the different surgical procedures and anesthetic techniques. The includes times for anesthesia preparation for 5 mins, anesthesia induction of 10 minutes and emergence times of 10 mins for total intravenous anesthesia; 20, 15, and 15 mins for inhalational anesthesia; 15, 10, 10 mins for spinal anesthesia; 20, 25, 10 mins for epdural anesthesia and 10, 25, and 15 minutes for combined general-regional anesthesia.
Conclusion. It is imperative to standardize ACTs in order to reduce variability and improve efficiency. The first step in achieving this goal is to describe the standards in a particular institution, which in turn may be used as a benchmark by other institutions in a similar settings.
Key Words: anesthesia-controlled time, anesthesia preparation, anesthesia induction, emergence time, OR efficiency, benchmark