Sustained increases in productivity with maintenance of quality in an academic anesthesia practice
Previously, the authors reported trends in anesthesia quality and productivity in a university-based anesthesia practice as it responded to increasing service demands with shortages of qualified staff and decreasing reimbursement. From 1992 to 1997, productivity increased, with a significant decrease in patient injury. In this study, we analyzed whether previous productivity and quality gains were sustained from 1998 to 2000 despite continued staff shortages. Productivity, caseload, and outcome data were abstracted from departmental administrative and quality-improvement reports. Retrospective cohort analysis compared trends during 3 yr of moderate productivity (1994-1996) with those during 3 yr of high productivity (1998-2000). The mean monthly productivity in 1998-2000 (15 ± 0.6 billed hours per attending per clinical day) was larger than levels from 1994 to 1996 (mean, 14 ± 0.7 h; P < 0.01). The overall continuous quality improvement report rate was slower at larger productivity levels, as were rates of patient injuries. When adjusted for declining report rates, patient injury rates showed no change between smaller- and larger-productivity years. Adjusted rates of operational inefficiencies and human errors were more frequent at larger productivity levels. Although the pressures of increased demands, shrinking resources, and shortages of qualified academic anesthesiologists have not abated, productivity and quality have been sustained. Future management must be directed toward reductions in operational inefficiencies and human error.