Using Performance Frontiers To Evaluate Non-OR Anesthesia (NORA) Efficiency

Area of Science:

• Anesthesiology
• Healthcare Operations
• Performance Measurement

Background:

• Operating room (OR) suites commonly use performance dashboards for efficiency, but non-operating room anesthesia (NORA) sites face unique challenges.
• Existing productivity frameworks inadequately guide improvements in NORA operational efficiency.
• Performance frontiers, effective for ORs, have not been applied to NORA settings.

Purpose of the Study:

• To apply performance frontiers to assess NORA site efficiency.
• To identify potential operational strategies for improving NORA delivery.
• To evaluate the variability in NORA site performance.

Main Methods:

• Anesthesia billing records from a primary hospital (April 2022–March 2023) were analyzed.
• Cases from OR and NORA locations were included, excluding those with irregular volume or financial arrangements.
• Under-utilized and over-utilized minutes were calculated, and data were plotted as rolling 4-week sums normalized to scheduled NORA block time (7 AM–5 PM on non-holiday weekdays).
• Performance frontiers were developed and plotted to visualize efficiency.

Main Results:

• Over 246 weekdays, 42,424 cases were analyzed, with 20,003 (47.2%) NORA cases and 22,421 (52.8%) OR cases.
• Performance frontiers demonstrated significant efficiency variability across NORA sites.
• Nonparametric tests confirmed statistical significance and non-equivalence in performance.

Conclusions:

• Performance frontiers highlight substantial efficiency variability in NORA sites, necessitating targeted interventions.
• Some NORA sites achieve OR efficiency levels, while others lag, especially those with high variability and urgency.
• Efficient sites can optimize resource allocation using performance frontiers; inefficient sites may benefit from shared resource pools.