ECONOMICS,EDUCATION, AND HEALTH SYSTEMS RESEARCH SECTION EDITOR RONALD D. MILLER Organizational Factors Affect Comparisons of the Clinical Productivity of Academic Anesthesiology Departments Amr E. Abouleish, MD, MBA*, Donald S. Prough, MD*, Steven J. Barker, MD, PhD†, Charles W. Whitten, MD‡, Tatsuo Uchida, MS§, and Jeffrey L. Apfelbaum, MD *Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas; †Department of Anesthesiology, University of Arizona, Tucson, Arizona; ‡Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas; §Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas; and Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois Productivity measurements based on “per operating room (OR) site” and “per case” are not influenced by staffing ratios and have permitted meaningful compar- isons among small samples of both academic and private-practice anesthesiology groups. These compar- isons have suggested that a larger sample would allow for clinical groups to be compared using a number of different variables (including type of hospital, number of OR sites, type of surgical staff, or other organiza- tional characteristics), which may permit more focused benchmarking. In this study, we used such grouping variables to compare clinical productivity in a broad survey of academic anesthesiology programs. Descrip- tive, billing, and staffing data were collected for 1 fiscal or calendar year from 37 academic anesthesiology de- partments representing 58 hospitals. Descriptive data included types of surgical staff (e.g., academic versus private practice) and hospital centers (e.g., academic medical centers and ambulatory surgical centers [ASCs]). Billing and staffing data included total num- ber of cases performed, total American Society of Anes- thesiologists units (tASA) billed, total time units billed (15-min units), and daily number of anesthetizing sites staffed (OR sites). Measurements of total productivity (tASA/OR site), billed hours per OR site per day (h/ OR/d), surgical duration (h/case), hourly billing pro- ductivity (tASA/h), and base units/case were com- pared. These comparisons were made according to type of hospital, number of OR sites, and type of surgical staff. The ASCs had significantly less tASA/OR site, fewer h/OR/d, and less h/case than non-ASC hospi- tals. Community hospitals had significantly less h/OR/d and h/case than academic medical centers and indigent hospitals and a larger percentage of private-practice or mixed surgical staff. Academic staffs had significantly less tASA/h and significantly more h/case. tASA/h correlated highly with h/case (r =-0.68). This study showed that the hospitals at which academic anesthesiology groups provide care are not all the same from a clinical productivity perspective. By grouping based on type of hospital, number of OR sites, and type of surgical staff, academic anesthesiology de- partments (and hospitals) can be better compared by using clinical productivity measurements based on “per OR site” and “per case” measurements (tASA/ OR, billed h/OR/d, h/case, tASA/h, and base/case). (Anesth Analg 2003;96:802–12) B enchmarking is defined as comparing perfor- mance by using specified definitions with other groups, or against industry-wide data, to assess operational effectiveness and productivity of an in- dividual group (1). Benchmarking the performance of anesthesiology groups can be particularly chal- lenging because of the differences in staffing ratios (i.e., concurrency) between groups (2). Because of this, using traditional “per full-time-equivalent (FTE)” measurements may lead to inaccurate con- clusions because a group in which physicians per- sonally administer most anesthetics will appear to produce fewer units per FTE than one in which anesthesiologists concurrently supervise more than one nurse anesthetist, anesthesia assistant, or resi- dent (3). In contrast, productivity measurements based on “per anesthetizing operating room (OR) site” and “per case” are not influenced by differences in concurrency and thus permit more meaningful comparisons Supported by departmental funds only (University of Texas Med- ical Branch, Galveston, TX). Presented at the 2002 annual meeting of the American Society of Anesthesiologists in Orlando, FL, October 14, 2002. Accepted for publication November 18, 2002. Address correspondence and reprint requests to Amr E. Abouleish, MD, MBA, Department of Anesthesiology, The Univer- sity of Texas Medical Branch, Galveston, TX 77555-0591. Address e-mail to aaboulei@utmb.edu. DOI: 10.1213/01.ANE.0000049689.66901.61 ©2003 by the International Anesthesia Research Society 802 Anesth Analg 2003;96:802–12 0003-2999/03