title: Case Sequencing of Diagnostic Imaging Studies Performed Under General Anesthesia or Monitored Anesthesia Care During Nights and Weekends.
abstract: General anesthesia or monitored anesthesia care sometimes is provided in nonoperating room (OR) locations during nights and weekends (e.g., for magnetic resonance imaging [MRI] or computerized tomography [CT]). Rational and consistent scheduling and sequencing decisions for these diagnostic imaging procedures, including coordination with OR cases, cannot be done without knowing how long each case can wait to be started without risking a worsening of the patient's condition. We reviewed the medical records of the 81 patients who underwent diagnostic imaging procedures (78 = MRI, 3 = CT scan) under general anesthesia or monitored anesthesia care either on weekends or between 6 pm and 6 am at the University of Iowa Hospitals between March 2012 and February 2014. For 77.8% of patients, the indications could have changed clinical management within 4 hours (N = 63/81). Among the 63 imaging studies with potential immediate impact, there was documentation of results having been communicated to the treating team within 4 hours of the completion of imaging for 39 of the patients. Among the 39 patients, 15 promptly received medications or underwent procedures based on the imaging results. Thus, 15 of the 81 patients had a change in care (18.5%, 95% lower confidence limit = 11.2%). Our results are important since we showed previously that it is not possible to make rational and consistent decisions in case sequencing without knowing how long each case (including diagnostic imaging procedures) can wait to be started without a change in the patient's risk. The scheduled surgical procedure itself provides sufficient information to assess safe waiting times to start add-on cases (e.g., appendectomy). In contrast, MRI provides no context as to how potential findings will influence treatment. Our results show that the assumption cannot reasonably be made when sequencing cases that all imaging studies can or cannot wait longer than pending surgical procedures. Our results show that, for evidence-based OR management decision-making, information to decide appropriate waiting should be obtained electronically or verbally for each imaging study.
authors.affiliation: From the *Department of Anesthesia, University of Iowa, Iowa City, Iowa; †Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa; and ‡Department of Industrial Engineering & Operations Research, Columbia University, New York, New York.
authors.forename: Rashmi N
authors.initials: RN
authors.lastname: Mueller
authors.forename: Franklin
authors.initials: F
authors.lastname: Dexter
authors.forename: Van-Anh
authors.initials: VA
authors.lastname: Truong
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Wachtel
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007484:Iowa; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult