on monitoring and management of patients by the anaesthetists in operating room and post anaesthesia care. Anaesthesiologist activities in emergency medicine, intensive care and even pain management are in general not recognized or minimized. Conclusion(s): From the data gathered it is clear the need to make more visible the scope of knowledge and activities of anaesthesiologists. This is in our view even more crucial if one consider that the results were obtained from future professionals and the importance of implicit and explicit knowl- edge of one’s skills inside a team Reference: To Err Is Human: Building a Safer Health System, Institute of Medicine, 2000 1AP1-3 Efficient operating room management: an empirical analysis of german hospitals M. Berry, T. Berry-Stoelzle, A. Schleppers Institute for Anesthesiology and Operative Intensive Medicine, Klinikum Mannheim, Mannheim, Germany Background and Goal of Study: The goal of this study is to evaluate the cost efficiency of different OR management forms empirically. Materials and Methods: We use cross-sectional data from a survey of all Anesthesiology departments in German hospitals for the year 2002. We develop hypotheses about the effect of structural, organizational and work- flow components of the OR management process on OR efficiency. These components are taken out of existing management literature as well as sug- gestions from practitioners. To test our hypotheses, we develop a new proxy for operating room efficiency and regress variables which describe the dif- ferent OR management forms on this proxy. Results and Discussions: While the size of the hospital is the most impor- tant factor for increasing OR efficiency, the enforcement capacity of the OR manager is the single influential factor which is independent of external con- straints. A hospital cannot change its size easily, but can equip its OR man- ager with the power necessary for this position. Conclusion(s): The analysis shows that while structural characteristics have an important influence on OR efficiency, the implementation of the ele- mentary management functions planning and controlling are critical to effi- cient OR performance. 1AP1-4 The ratio between anaesthesia and surgical procedure time as a controlling tool in the operating room T. Kaufmann, C. Cheah, G. Schuepfer Department of Anesthesiology, Kantonsspital Lucerne, Lucerne, Switzerland Background and Goal of Study: Anaesthesia time (AT) and incision-to-suture time (IST) are important variables representing the production process in the Operating room (OR). The Ratio (R = AT/IST) between these two times is dependant on different variables and may also reflect the productivity in an OR. Therefore these times were analysed and assessed for simple influencing fac- tors such as emergency versus elective situations and the surgical disciplines. Materials and Methods: 40024 consecutive anaesthesia records of a gen- eral hospital were included in this study representing a 2 year period. 435 records had to be excluded because of inconsistent data. At is defined as the time from the first contact with the patient till its transfer to the PACU or ICU. The Ratio (R) of AT divided by IST was calculated. Results and Discussions: The mean surgical duration of a procedure (IST) was 66 minutes (min)  69 standard deviation (S.D.) min for all 39589 cases (median: 45 min). The mean R was 2,62, the median 2,27 and the mode 2,0  6,25 S.D. 30698 (77,54%) procedures were elective and 8891 emer- gency cases. Mean ART, IST and R were statistically different between elec- tive and surgical cases (p  0.01, R elective mean 2,9  3.2 S.D. and R emergency mean 3,2 4,0 S.D.). The following surgical disciplines were included (mean R): General Surgery: 20,83% (R 2,97), plastic surgery 6,87% (R 3,5), obstetrics and gynaecology 11,72% (R 3,2), vascular 3,08% (R 2,8), orthopaedics 5,5% (R 2,73), urology 4% (R 2,97), ophthalmology 16,18% (R 2,64), paediatrics 14,23% (R 3,4), ENT 8,92% (R 2,9), mandible-facial sur- gery 2,28% (R 2,51), adult heart surgery 2,51% (R 2,12) and neurosurgery 1,29% (R 2,4). In a regression model the surgical discipline (p 0.03) and case urgency (p0.02) influenced R statistically significant. Conclusion(s) and discussion: R is dependant of the surgical discipline and the urgency of the case. It is a variable tool together with other data to analyze productivity in the OR, but R is clearly dependant on the definition of AT, which may also influenced by local settings. 1AP1-6 Measurements of psychomotor performance of anesthesiologists during the 24-hours in-hospital call M. Carev, N. Karanovic, A. Ujevic, G. Kardum, Z. Dogas Department of Anesthesiology and Intensive Care, University of Split School of Medicine, Split, Croatia Background and Goal of Study: Anesthesiologists’ work along with extended duty shifts is combined with intensive stress (1). Moreover, anesthesia practice requires sustained vigilance, parallel decision-making, and fine motor skills. The aim of this study was to find out the impact of sleep deprivation, fatigue and stress on anesthesiologists’ psychomotor performances, measured by the CRD (Complex Reactionmeter Device), a computer based psychometric system, able to detect even discrete psychological and mental changes (2). Materials and Methods: After the Medical Ethics Committee approval and informed consent, 27 staff anesthesiologists (35–55 yrs) were tested. A battery of 4 computer-generated cognitive psychological tests was used to record 2 parameters of cognitive performance: total test solving time (TTST – describing speed of reactions), and variability of reaction time (VRT-attention, alert- ness). Two tests were made during on call (8 am and 4 pm i.e. D8, D16), and two during the ordinary working day (8 am, 4 pm, i.e. WD8, WD16). ANOVA for repeated measures and LSD post-hoc test were used. Results and Discussions: Tests Tasks D8 D16 WD8 WD16 p AO 35 TTST 141  37 141  35 118  28 113  21 0,001 VRT 53  18 65  17 49  11 43  9 0,001 SV 35 TTST 49  10 50  11 45  7 44  5 0,001 VRT 17  4 17  4 14  4 15  4 0,049 DLP 60 TTST 37  3 38  4 35  5 36  6 0,117 VRT 10  3 11  2 10  3 12  4 0,078 LAC 35 TTST 50  31 45  12 37  11 36  11 0,059 VRT 25  16 25  10 20  9 19  11 0,069 AO = arithmetic operation, SV = spatial visualization, DLP = discrimination of light position, LAC = leg and arm coordination; results times given in seconds. Conclusions: Comparing TTST and VRT, the test results were worse while on duty, implicating reduced speed of reaction, as well as attention and alertness. Anesthesiologists have impaired performance in cognitive com- plex reaction time tests during on call day, suggesting increased stress for an on call anesthesiologist, and this deserves further research. We consider CRD as a valuable tool for precise psychomotor testing. References: 1 Anaesthesia 2006; 61: 856–66. 2 http://www.crd.hr/ (accessed on December 14, 2006). 1AP1-7 Fast track rehabilitation of patients undergoing major abdominal surgery K. Oremus, V. Majeric-Kogler, D. Tonkovic, D. Korolija, M. Skegro Anaesthesiology and intensive care medicine, University Hospital Center Zagreb, Zagreb, Croatia Background and Goal of Study: It has been proposed that a fast track (FT) programme omitting preoperative fasting, bowel preparation, routine abdom- inal drainage and NG tube insertion, together with epidural analgesia, infusion volume restriction, early enteral nutrition and mobilization, can reduce peri- operative stress and enhance recovery without compromising patient safety(1). Our aim was to implement such a protocol and verify its safety. Materials and Methods: During a 6 month period 30 patients undergoing major abdominal surgery were treated according to FT principles. Median age 63 yrs (40–88), 18/30 female, 77% (23) ASA I&II, 23% (7) ASAIII. Continuous 24 hour perioperative epidural infusion of levobupivacaine 0.125% & tramadol 5 mg/ml commenced preoperatively, supplemented by NSAIDs postopera- tively. All admitted for 24 hr ICU observation, where enteral nutrition and mobilization started 5 hrs postoperatively. VAS pain score assessed 4 hourly during 24 hrs. A matched control group (group C) of 30 patients operated during the same period received “traditional” care. Independent samples t-test and ANOVA were used for result analysis and group comparison. Results and Discussions: Mean (FT/C) Range p First stool passage(day) 2,6/4,28 1–5/2–7 0.001 Discharge (days) 7,64/10,44 6–18/7–16 0.001 No significant differences in VAS scores and complication rates between groups. No complications needing surgical revision in FT group. Three FT patients had complications prolonging hospitalization (wound infection, urinary Evidence based practice and quality assurance 3