策略性增加手术单元时间以扩充手术室容量不应基于手术室利用率

背景当决定扩充手术室容量时，选择让外科亚专业接受增加的手术单元时间以填充手术室容量是一项战术性决策。这样的决策大约每年出炉1次。然而，通常在手术前的数月，又会出现第2方案，即根据预期的工作量来分配手术室的时间以及亚专业人员的时间。实践中，在已计划好的手术单元时间内不可能安排手术，手术应安排到有人员配置的时间内。本文回顾了有关扩充手术室容量的战术性决策的文献。当增加的手术室容量可以利用时，应该分配给那些单位手术时间利润额最大的亚专科的亚专业，它们具有发展潜力，并且对有限资源的需求小，如重症监护室（ICU）床位。有许多原因可以解释为什么安排附加手术单元时间不应基于当前或过去的利用率。

When a decision has been made to expand operating room （OR） capacity, the choice of surgical subspecialties to receive additional block time and fill the additional OR capacity is a tactical decision. Such decisions are made approximately once a year. Afterwards, typically a few months before the day of surgery, a second stage occurs in which operational decisions allocate OR time and determine the hours of staffing for each specialty based on its expected workload. In practice, cases are not scheduled into block time that has been planned tactically, but instead are scheduled during the second stage into the staffed time that is allocated operationally. This article reviews the literature on tactical decisionmaking for expansion of OR capacity. When additional OR capacity is available, it should be planned for those subspecialties that have the greatest contribution margin per OR hour, that have the potential for growth, and that have minimal need for limited resources such as intensive care unit beds. Numerous reasons are presented to explain why tactical planning of additional block time should not be based on current or past utilization of block time.