Impact of anesthesia resident staff assignment decisions on nurse anesthetist and anesthesia resident staff scheduling and productivity: Tutorial using data from a pediatric hospital

Abstract

Background: Most large US teaching hospitals have anesthesia fellows, anesthesia residents, and nurse anesthetists or anesthesiologist assistants. The objective of the tutorial is the review of how fellow and resident staff scheduling and staff assignment decisions can influence not only their productivity but that of the nurse anesthetists (or anesthesiologist assistants). Methods: We developed scenarios for this tutorial using data from 35 consecutive Tuesdays at a pediatric hospital, May through December 2020. This organizational case study used given probability distributions of workload, along with the resulting allocations of anesthesia time based on minimizing the inefficiency of use of anesthesia providers. Four scenarios were created. Results: One scenario highlights that if (a) residents are assigned to cases based on the procedure category corresponding to their rotation, (b) the workday at that anesthetizing location is relatively brief, and (c) the residents are not assigned also to start one or two brief cases of different types, then productivity can be reduced substantially because of variability among operating rooms in the daily hours of cases. Another scenario highlights that productivity would be greater if the resident rotation included a pair of two specialties that took into account expected durations of the workday for the paired specialties. Conclusions: Our tutorial highlights how the effect of resident staff assignments on anesthesia group productivity can be substantial because functionally, their minimum shift length would not be known from the staff schedules months in advance but instead only be realized upon the day of surgery. When a department is investigating reasons for apparently lower nurse anesthetists’ (or anesthesiologist assistants’) and anesthesia residents’ productivity, assignments based on first case starts, for whatever educational or other reasons, but not considering the duration of the workday should be part of the differential diagnosis.