BJA Advance Access published online on February 16, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem003
Consequences of running more operating theatres than anaesthetists to staff them: a stochastic simulation study
1 Department of Epidemiology, Biostatistics and Clinical Research, University Hospital Bichat–Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France
2 Service d'Anesthésie–réanimation SAMU–SMUR 94, Hôpital Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil Cedex, France
* Corresponding author: Service d'Anesthésie–réanimation SAMU–SMUR 94, Hôpital Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil Cedex, France. E-mail: jean.marty{at}hmn.aphp.fr
BACKGROUND: Numerous hospitals implement a ratio of one anaesthetist supervising non-medically-qualified anaesthetist practitioners in two or more operating theatres. However, the risk of requiring anaesthetists simultaneously in several theatres due to concurrent critical periods has not been evaluated. It was examined in this simulation study.
METHODS: Using a Monte Carlo stochastic simulation model, we calculated the risk of a staffing failure (no anaesthetist available when one is needed), in different scenarios of scheduling, staffing ratio, and number of theatres.
RESULTS: With a staffing ratio of 0.5 for a two-theatre suite, the simulated risk that at least one failure occurring during a working day varied from 87% if only short operations were performed to 40% if only long operations performed (65% for a 50:50 mixture of short and long operations). Staffing-failure risk was particularly high during the first hour of the workday, and decreased as the number of theatres increased. The decrease was greater for simulations with only long operations than those with only short operations (the risk for 10 theatres declined to 12% and 74%, respectively). With a staffing ratio of 0.33, the staffing-failure risk was markedly higher than for a 0.5 ratio. The availability of a floater for the whole suite to intervene during failure strongly lowered this risk.
CONCLUSIONS: Scheduling one anaesthetist for two or three theatres exposes patients and staff to high risk of failure. Adequate planning of long and short operations and the presence of a floating anaesthetist are efficient means to optimize site activity and assure safety.
Keywords: model, Monte Carlo simulation; monitoring, anaesthetist activity; risk; staffing ratio
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