title: Overlapping induction of anesthesia: an analysis of benefits and costs.
abstract: BACKGROUND
  Overlapping induction (OI), i.e., induction of anesthesia with an additional team while the previous patient is still in the operating room (OR), was investigated.
  
  
  METHODS
  The study period was 60 days in two followed by three ORs during surgical Block Time (7:30 am until 3:00 pm). Patients were admitted the day before surgery and were thus available and did not have surgery that day unless there was a time reduction. Facilities were already constructed. Number of cases, Nonsurgical Time (Skin Suture Finish until next Procedure Start Time), Turnover Time, and Anesthesia Control Time plus Turnover Time were studied. In addition, economic benefit was calculated.
  
  
  RESULTS
  Three hundred thirty-five cases were studied. Using OI, the time of care of regularly scheduled cases was shortened, and the number of cases performed within OR Block Time increased (151 to 184 cases; P < 0.05). Nonsurgical Time (in h:min) decreased (1:08 +/- 0:26 to 0:57 +/- 0:18; P < 0.001), Turnover Time decreased (0:38 +/- 0:24 to 0:25 +/- 0:15; P < 0.05), and Anesthesia Control Time plus Turnover Time decreased (0:43 +/- 0:23 to 0:28 +/- 0:18; P < 0.001). Subgroup analysis showed a significant benefit of OI only in three ORs. In three ORs, economic benefit can be gained at a case mix index greater than 0.3 besides additional costs.
  
  
  CONCLUSIONS
  Overlapping induction increased productivity and profit despite the expense of additional staff. Subgroup analysis emphasizes the importance of the number of ORs involved in OI.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. hanss@anesthesie.uni-kiel.de
authors.forename: Robert
authors.initials: R
authors.lastname: Hanss
authors.forename: Björn
authors.initials: B
authors.lastname: Buttgereit
authors.forename: Peter H
authors.initials: PH
authors.lastname: Tonner
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
authors.forename: Andreas
authors.initials: A
authors.lastname: Schleppers
authors.forename: Markus
authors.initials: M
authors.lastname: Steinfath
authors.forename: Jens
authors.initials: J
authors.lastname: Scholz
authors.forename: Martin
authors.initials: M
authors.lastname: Bauer
mesh_terms: D000758:Anesthesia / Q000191:economics*; D001071:Appointments and Schedules; D003365:Costs and Cost Analysis; D004526:Efficiency; D006801:Humans; D009873:Operating Rooms; D013997:Time Factors