Computer simulation to determine how rapid anesthetic recovery protocols to decrease the time for emergence or increase the phase I postanesthesia care unit bypass rate affect staffing of an ambulatory surgery center

Ambulatory surgery centers (ASC) are implementing new anesthetic techniques and rapid recovery protocols in the postanesthesia care unit (PACU) to ach ieve earlier discharge after general anesthesia. Using computer simulation, we addressed two questions. First, what is the decrease in an ASC's operat ing room (OR) staff if the time from which the surgery is finished to the t ime the patient leaves the OR is decreased? Second, what is the decrease in PACU nursing staffing if patients bypass phase I PACU (i.e., proceed from the OR directly to the phase II PACU)? The decrease in labor costs from rap id emergence or fast-tracking depends on how staff are compensated, how man y ORs routinely run concurrently, and what percentage of patients undergo g eneral anesthesia. The results show potential decreases in ASCs' labor cost s ($7.39 per case) from technologies (e.g., new anesthetics or Bispectral I ndex(TM) [Aspect Medical Systems, Natick, MA] monitoring) to decrease emerg ence times or increase the phase I bypass rates. Implications: Decreases in operating room and postanesthesia care unit labor costs resulting from fas ter emergence and phase I postanesthesia care unit bypass vary depending on the amount of routine overtime, how the staff are compensated, and how man y patients are routinely anesthetized each day.