Abstract No. 588 Effect of relative increase in nurse and technologist staff: utilizing lower COVID-19 case volume as a model for examining increased staffing ratio on room turnover efficiency

Purpose: Efficient interventional radiology (IR) procedure room utilization relies on various healthcare professionals performing clinical and nonclinical tasks to minimize room downtime. The coronavirus-19 (COVID) pandemic offers insight into the importance of staff ratios in improving room utilization, by evaluating the effect of a relative increase in support staffing in the setting of reduced physician staffing and reduced overall case volume. Materials and Methods: In March 2020, as a result of a department-wide COVID disaster management plan, a 4-angiosuite IR department in a 900-bed tertiary care center experienced reduced case volume by approximately 1/3, matched by decreased physician staffing (3 to 2 attendings). IR technologist and nurse staffing remained unchanged. Normal staffing resumed June 2020. A prospective database of event times related to room workflow was reviewed for case volume, room turnaround time, and first case delay time before and after volume and staff changes. Turnaround times greater than 2 hours were excluded to correct for gaps in schedule and the prolonged turnaround associated with COVID-positive patient cases. Wilcoxon rank-sum two-sample tests were used to evaluate the differences between time periods. All P values reported are two-sided. Analysis was done in RStudio 1.2.5033 (RStudio Team, Boston, MA). Results: Under standard operation, the median values for room turnaround time, case start delay, weekly case volume, and total case hours were 43.0 minutes, 30.0 minutes, 64 cases, and 44.4 hours, respectively. Under the COVID disaster management plan, a 32.6% (P < 0.001, 95% C.I. 23.3%, 41.9%) estimated increase was observed for room turnaround times, and a 53% (P < 0.001, 95% C.I. 36.7%, 70.0%) estimated increase was observed in case start delay;despite a 29.7% (P < 0.001, 95% C.I. 20.3%, 42.2%) decrease in case number and 29.5% (P = 0.009, 95% C.I. 13.1%, 43.2%) estimated decrease in total case hours. Conclusions: Paradoxically, a relative increase in staffing did not improve measured metrics for room utilization, despite a stable attending physician-to-case ratio. Rather, findings may be allegorical to Parkinson’s law suggesting that work expands so as to fill the time available for its completion.