title: Task analysis of the preincision period in a pediatric operating suite: an independent observer-based study of 656 cases.
abstract: We designed this cross-sectional investigation to assess anesthesia release time (ART = patient-on-table until release for surgical preparation) and surgical preparation time (start of surgical preparation to incision) of children undergoing anesthesia and surgery (n = 656). Data collected by trained independent observers included variables such as age, ASA physical status, anesthetic technique, and placement of invasive monitoring. We found that mean ART was 11.0 +/- 9.7 min and the mean surgical preparation time was 11.1 +/- 10.0 min. Also, ART ranged from 7 +/- 7 min (for mask anesthesia) to 52 +/- 18 min (general anesthesia/endotracheal tube and invasive hemodynamic monitoring). The percentage of ART of the total case length was 15% +/- 7%, with a wide variability depending on the total case length. We also found that there is a significant variability in ART as a function of the surgical service involved (analysis of variance; P = 0.0001), ASA physical status (P = 0.0001), and age. For example, younger children had a significantly longer ART as compared with older children (P = 0.001). Room coverage ratio by the attending anesthesiologist and training level of the anesthesia resident did not impact ART (P = not significant). We conclude that ART in children undergoing surgery is highly variable and is a function of factors such as the surgical service involved, age of the child, and ASA physical status of the child. These factors should be considered when scheduling a surgical case.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut 06520-8051, USA.
authors.forename: Haleh
authors.initials: H
authors.lastname: Saadat
authors.forename: Alejandro
authors.initials: A
authors.lastname: Escobar
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Davis
authors.forename: Jan
authors.initials: J
authors.lastname: Ehrenwerth
authors.forename: Gail
authors.initials: G
authors.lastname: Watrous
authors.forename: Gene S
authors.initials: GS
authors.lastname: Fisch
authors.forename: Zeev N
authors.initials: ZN
authors.lastname: Kain
authors.forename: Paul G
authors.initials: PG
authors.lastname: Barash
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000758:Anesthesia / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019370:Observation; D009873:Operating Rooms; D010372:Pediatrics / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000379:methods*; D017748:Time Management