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From Editor-in-Chief, Anesthesia & Analgesia; Department of Anesthesia, Stanford University, Stanford; and Department of Biopharmaceutical Sciences, University of California at San Francisco, California.
Address correspondence to Steven L. Shafer, MD, Department of Anesthesia, Stanford University, Stanford, California. Address e-mail to steven.shafer{at}stanford.edu.
In 1995, Drs. Franklin Dexter and John Tinker published a manuscript on decreasing the cost of care in the postanesthesia care unit (1). Over the following 11 yr, Dr. Dexter has published nearly 100 manuscripts on using mathematical and statistical approaches to optimizing the management of operating rooms. In the process, Dr. Dexter and his frequent collaborators, Drs. Epstein (Jefferson Medical College), Lubarsky (University of Miami), Macario (Stanford University), O’Neill (University of North TX), Traub (ND State University), and Wachtel (University of IA) have defined a new intellectual discipline for our specialty: operating room management. In the process, Dr. Dexter no longer performs liver transplants, his clinical specialty for many years, but devotes himself full time to helping hospitals improve the efficiency of their operating rooms as the Director of the Division of Management Consulting in the Departments of Anesthesia and Health Management and Policy at the University of IA.
The tools used to optimize operating room management are arcane: stochastic programming, similarity index, structural equation modeling, Monte Carlo simulation, bin packing algorithms, fuzzy constraints, mean variance analysis, data envelopment analysis, and Bayesian prediction bounds. Although the authors of these articles have worked hard to make the material tractable, nevertheless the articles are hard to read. I have heard from my academic colleagues that few understand the work. The only options for a hospital interested in using these advanced methodologies is to hire Dr. Dexter or one of his colleagues to do the analysis or to teach the hospital’s financial analysts or management engineers how to do the analysis.
A year ago, I challenged Dr. Dexter to write a "how to" guide for hospitals interested in applying advanced operating room management technologies to surgical case scheduling. Could he condense 10 yr of research and 50+ published manuscripts into a guide that did not require gray matter transfusions to understand and implement? My model was the surprisingly well written "For Dummies" series of publications.
The result is the manuscript "The Impact of Service-Specific Staffing, Case Scheduling, Turnovers, and First-Case Starts on Anesthesia Group and Operating Room Productivity: A Tutorial Using Data from an Australian Hospital" appearing in this issue of Anesthesia & Analgesia (2). Constructed around a real-life example of applying operating room management, the manuscript offers definitions and step-by-step instructions on how to go about improving operating room efficiency, using data routinely gathered during health care delivery. Any physician with a basic understanding of addition, subtraction, multiplication, and division should find the work tractable. Any hospital or anesthesia group interested in improving operating room efficiency should start with this article as a broad overview of the concepts and methodologies. The tables can serve as models for the hospital’s information system reports (i.e., "this is what we want").
On a separate topic, there is a potential conflict of interest between Dr. Dexter’s role as an author of many articles published in Anesthesia & Analgesia, and his role as Section Editor for Economics, Education, and Policy. At the time this editorial was written, Dr. Dexter’s section included at least two of his articles (2,3). To preclude conflict of interest I handle all of his submissions. His manuscripts get reviewed, critiqued, and occasionally rejected, just like any other author. I do the same for submissions from any Section Editor that would otherwise go to their section. Similarly, my submissions are handled by Ron Miller, our emeritus Editor-in-Chief, and I have no more control over their assignment or fate than any other author.
Dr. Dexter’s guide "The Impact of Service-Specific Staffing, Case Scheduling, Turnovers, and First-Case Starts on Anesthesia Group and Operating Room Productivity: A Tutorial Using Data From an Australian Hospital" not only survived the peer-review process, but met with enthusiastic endorsement as a "Case Scheduling for Dummies" guide that has long needed to be written. I agree, and hope that it provides insight into a discipline that has previously been veiled by the demanding methodologies needed for scientific validation.
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  S. L. Shafer Full Disclosure Matters! Anesth. Analg., March 1, 2008; 106(3): 1017 - 1017. [Full Text] [PDF]
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W. G. Maurer Ambulatory Anesthesia: Whither Thou Goest Anesth. Analg., May 1, 2007; 104(5): 1299 - 1299. [Full Text] [PDF]
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S. L. Shafer Ambulatory Anesthesia: Whither Thou Goest Anesth. Analg., May 1, 2007; 104(5): 1299 - 1300. [Full Text] [PDF]
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