Measuring Misery
The concept of an anesthesia misery index was introduced many years ago as an anesthesia practice management tool. It was intended as a tool to measure and assess the impact of contractual scope creep. While many hospital contracts included a schedule of coverage requirements, these often became obsolete as more cases kept being added late in the day. In other words, what started as a reasonable set of coverage requirements became downright challenging, thus contributing to provider misery. In an effort to track the impact of long days, advisers started tracking the percentage of cases and units generated after 5 PM and at night. The value of this misery index allowed practices to track changes to operating room utilization that impacted provider income and lifestyle.
The basic concept was to categorize billed units into three categories: those generated during normal weekdays from 7 AM to 5 PM, those generated after 5 PM and those generated on weekends. The pie chart below provides an example of a Coronis client. Typically, a higher percentage of units is generated during the day, which is what led this client to request this analysis.
Changing with the Times
Anesthesia staffing requirements have evolved considerably over the past decades. When most surgical cases were perfumed on an inpatient basis, a busy O.R. suite generated 50 to 60 ASA units per O.R. day.
While there were always some rooms that ran long with emergencies, the average room would finish by 4 or 5. The most dramatic change has been the migration of cases from inpatient venues to ambulatory and outpatient venues. This has resulted in a considerable increase in the number of anesthetizing locations and a corresponding drop in operating room productivity as measured in average units generated per location day. The dramatic increase in the number of anesthetics for colonoscopy has had a significant impact on O.R utilization. As hospitals have also added new lines of business, many of which have long ramp-up times to full production, these have tended to erode average O.R. productivity.
It is the rare day that can be defined as the perfect anesthesia provider day. Most providers prefer to start early, have a full day and get home at a reasonable time. Long breaks during the day are particularly frustrating. The line chart below provides an example of how case volumes can evolve over time. From January to December the percentage of units generated after 5 PM went from 27 percent to 31 percent.
The percentage of cases generated on weekends for this practice has remained constant at seven percent, which tells us the facility has not started booking more cases on the weekends; but this may not be the situation at other facilities. Every peak in units generated may require additional staffing. The question is always whether the peaks are part of a trend or exceptions.
Obviously, each practice is unique, and the metrics and trends will vary from site to site. This data can prove invaluable for staffing, coverage requirements and budgetary considerations, and it is a tool that is readily available to you. If you have any questions about these topics, please contact your account executive.