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Local Reg Anesth. 2019 May 24;12:37-46. doi: 10.2147/LRA.S183188. eCollection 2019.

Improving intraoperative handoffs for ambulatory anesthesia: challenges and solutions for the anesthesiologist.

Author information

Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA 52242, USA.
Department of Anesthesiology, University of Miami, Miami, FL, USA.


Permanent transitions of care from one anesthesia provider to another are associated with adverse events and mortality. There are currently no available data on how to mitigate these poor patient outcomes other than to reduce the occurrence of such handoffs. We used data from an ambulatory surgery center to demonstrate the steps that can be taken to achieve this goal. First, perform statistical forecasting using many months of historical data to create optimal, as opposed to arbitrary shift durations. Second, consider assigning the anesthesia providers designated to work late, if necessary, to the ORs estimated to finish the earliest, rather than latest. We performed multiple analyses showing the quantitative advantage of this strategy for the ambulatory surgery center with multiple brief cases. Third, sequence the cases in the 1 or 2 ORs with the latest scheduled end times so that the briefest cases are finished last. If a supervising anesthesiologist needs to be relieved early for administrative duties (eg, head of the group to meet with administrators or surgeons), assign the anesthesiologist to an OR that finishes with several brief cases. The rationale for these recommendations is that such strategies provide multiple opportunities for a different anesthesia provider to assume responsibility for the patients between cases, thus avoiding a handoff altogether.


case duration prediction; case sequencing; handoff; staff assignment; staff scheduling; staffing

Conflict of interest statement

Dr Franklin Dexter is Director of the Division of Management Consulting, Department of Anesthesia, University of Iowa. The Division provides consultations to corporations, hospitals, and individuals helping them with staffing analyses. In addition, the Division offers a course that Dr Dexter teaches that includes this topic. Dr Dexter receives no funds personally other than salary and allowable expense reimbursements from the University of Iowa, and has tenure with no incentive program. Dr Dexter has no financial holdings in any company related to his work, other than indirectly through mutual funds for retirement. The authors report no other conflicts of interest in this work.

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