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Woelfle CA, Geller JA, Neuwirth AL, Sarpong NO, Shah RP, Cooper HJ. Scheduling and Vendor Consistency Improves Turnover Time Efficiency in Total Joint Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00254-7. [PMID: 38522802 DOI: 10.1016/j.arth.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Maximizing operative room (OR) efficiency is important for hospital efficiency, patient care, and positive surgeon and staff morale. Reducing turnover time (TOT) has become a popular focus to improve OR efficiency. The present study evaluated if TOT is influenced by changing case type, implant vendor, and/or laterality. METHODS In total, 444 turnovers from January to July 2023 were retrospectively analyzed. All turnovers were same-surgeon turnovers between primary arthroplasty cases in dedicated, overlapping rooms. Single linear regression models tested the predictability of TOT based on case type, vendor, and laterality. A multivariate multiple regression and 1-way Analyses of Variance analyzed variables against each other. Independent sample t-tests evaluated TOTs when all variables were the same or different. RESULTS Changing versus keeping the same case type increased TOT by 2.4 minutes (95% confidence interval [CI] = 0.7, 4.0; P = .004). Changing vendors increased TOT by 2.9 minutes (95% CI = 1.1, 4.7; P = .002). Laterality did not affect TOT, with a change of 0.9 minutes (95% CI = -0.6, 2.5; P = .229). Vendor (P = .030) independently predicted TOT when analyzed as a covariate with case type (P = .410). The TOT with same case type and vendor (mean 38.2 minutes; range, 22 to 62) was less than that of different case types and vendors (mean 41.4 minutes; range, 26 to 73) (P = .017). Mean TOT differed by 5.5 minutes when keeping all variables the same versus all different (P = .018). CONCLUSIONS Maintaining a consistent case type, vendor, and laterality had a synergistic effect in reducing TOT in arthroplasty ORs with the same primary surgeon running 2 overlapping rooms. Changing vendor representatives was found to independently predict TOT increases, which is likely attributed to a disruption in workflow and collaboration of the multidisciplinary OR team. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Catelyn A Woelfle
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Jeffrey A Geller
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Dexter F, Epstein RH. Lack of Validity of Absolute Percentage Errors in Estimated Operating Room Case Durations as a Measure of Operating Room Performance: A Focused Narrative Review. Anesth Analg 2024:00000539-990000000-00784. [PMID: 38446709 DOI: 10.1213/ane.0000000000006931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Commonly reported end points for operating room (OR) and surgical scheduling performance are the percentages of estimated OR times whose absolute values differ from the actual OR times by ≥15%, or by various intervals from ≥5 to ≥60 minutes. We show that these metrics are invalid assessments of OR performance. Specifically, from 19 relevant articles, multiple OR management decisions that would increase OR efficiency or productivity would also increase the absolute percentage error of the estimated case durations. Instead, OR managers should check the mean bias of estimated OR times (ie, systematic underestimation or overestimation), a valid and reliable metric.
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Cohen TN, Kanji FF, Zamudio J, Shouhed D, Gewertz BL, Sax HC. Why can't we improve turnover time? A systematic review. World J Surg 2024; 48:72-85. [PMID: 38686762 DOI: 10.1002/wjs.12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND Despite substantial efforts to reduce operating room (OR) turnover time (TOT), delays remain a frustration to physicians, staff, and hospital leadership. These efforts have employed many systems and human factor-based approaches with variable results. A deeper dive into methodologies and their applicability could lead to successful and sustained change. The aim of this study was to conduct a systematic review to evaluate relevant research focused on improving OR TOT and clearly defining measures of successful intervention. MATERIAL AND METHODS A systematic review of OR TOT interventions implemented between 1980 through October 2022 was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Research databases included: 1) PubMed; 2) Web of Science; and 3) OVID Medline. RESULTS A total of 38 articles were appropriate for analysis. Most employed a pre/post intervention approach (29, 76.3%), the remaining utilized a control/intervention approach. Nine intervention methods were identified: the majority included a process redesign bundle (24, 63%), followed by overlapping induction, dedicated unit/team/space feedback, financial incentives, team training, education, practice guidelines, and redefinition of roles/responsibilities. Studies were further categorized into one of two groups: (1) those that utilized predetermined interventions based on anecdotal experience or prior literature (18, 47.4%) and (2) those that conducted a prospective analysis on baseline data to inform intervention development (20, 52.6%). DISCUSSION There are significant variability in the methodologies utilized to improve OR TOT; however, the most effective solutions involved process redesign bundles developed from a prospective investigation of the clinical work-system.
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Affiliation(s)
- Tara N Cohen
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, California, USA
| | - Falisha F Kanji
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, California, USA
| | - Jennifer Zamudio
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, California, USA
| | - Daniel Shouhed
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, California, USA
| | - Bruce L Gewertz
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, California, USA
| | - Harry C Sax
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, California, USA
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Schenk M, Neumann J, Adler N, Trommer T, Theopold J, Neumuth T, Hepp P. A comparison between a maximum care university hospital and an outpatient clinic - potential for optimization in arthroscopic workflows? BMC Health Serv Res 2023; 23:1313. [PMID: 38017443 PMCID: PMC10685488 DOI: 10.1186/s12913-023-10259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Due to the growing economic pressure, there is an increasing interest in the optimization of operational processes within surgical operating rooms (ORs). Surgical departments are frequently dealing with limited resources, complex processes with unexpected events as well as constantly changing conditions. In order to use available resources efficiently, existing workflows and processes have to be analyzed and optimized continuously. Structural and procedural changes without prior data-driven analyses may impair the performance of the OR team and the overall efficiency of the department. The aim of this study is to develop an adaptable software toolset for surgical workflow analysis and perioperative process optimization in arthroscopic surgery. METHODS In this study, the perioperative processes of arthroscopic interventions have been recorded and analyzed subsequently. A total of 53 arthroscopic operations were recorded at a maximum care university hospital (UH) and 66 arthroscopic operations were acquired at a special outpatient clinic (OC). The recording includes regular perioperative processes (i.a. patient positioning, skin incision, application of wound dressing) and disruptive influences on these processes (e.g. telephone calls, missing or defective instruments, etc.). For this purpose, a software tool was developed ('s.w.an Suite Arthroscopic toolset'). Based on the data obtained, the processes of the maximum care provider and the special outpatient clinic have been analyzed in terms of performance measures (e.g. Closure-To-Incision-Time), efficiency (e.g. activity duration, OR resource utilization) as well as intra-process disturbances and then compared to one another. RESULTS Despite many similar processes, the results revealed considerable differences in performance indices. The OC required significantly less time than UH for surgical preoperative (UH: 30:47 min, OC: 26:01 min) and postoperative phase (UH: 15:04 min, OC: 9:56 min) as well as changeover time (UH: 32:33 min, OC: 6:02 min). In addition, these phases result in the Closure-to-Incision-Time, which lasted longer at the UH (UH: 80:01 min, OC: 41:12 min). CONCLUSION The perioperative process organization, team collaboration, and the avoidance of disruptive factors had a considerable influence on the progress of the surgeries. Furthermore, differences in terms of staffing and spatial capacities could be identified. Based on the acquired process data (such as the duration for different surgical steps or the number of interfering events) and the comparison of different arthroscopic departments, approaches for perioperative process optimization to decrease the time of work steps and reduce disruptive influences were identified.
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Affiliation(s)
- Martin Schenk
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany.
- Department of Orthopaedic, Trauma and Plastic Surgery, Division of Arthroscopic Surgery and Sports Medicine, University of Leipzig Medical Center, Leipzig, Germany.
| | - Juliane Neumann
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Nadine Adler
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
- Department of Orthopaedic, Trauma and Plastic Surgery, Division of Arthroscopic Surgery and Sports Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Jan Theopold
- Department of Orthopaedic, Trauma and Plastic Surgery, Division of Arthroscopic Surgery and Sports Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Pierre Hepp
- Department of Orthopaedic, Trauma and Plastic Surgery, Division of Arthroscopic Surgery and Sports Medicine, University of Leipzig Medical Center, Leipzig, Germany
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Schouten AM, Flipse SM, van Nieuwenhuizen KE, Jansen FW, van der Eijk AC, van den Dobbelsteen JJ. Operating Room Performance Optimization Metrics: a Systematic Review. J Med Syst 2023; 47:19. [PMID: 36738376 PMCID: PMC9899172 DOI: 10.1007/s10916-023-01912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/26/2022] [Indexed: 02/05/2023]
Abstract
Literature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of 'optimization' has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular, the metrics used to quantify OR performance are diverse so that assessing the impact of suggested approaches is complex or even impossible. To secure a higher implementation success rate of optimisation strategies in practice we believe OR optimisation and its quantification should be further investigated. We aim to provide an inventory of the metrics and methods used to optimise the OR by the means of a structured literature study. We observe that several aspects of OR performance are unaddressed in literature, and no studies account for possible interactions between metrics of quality and efficiency. We conclude that a systems approach is needed to align metrics across different elements of OR performance, and that the wellbeing of healthcare professionals is underrepresented in current optimisation approaches.
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Affiliation(s)
- Anne M Schouten
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands.
| | - Steven M Flipse
- Science Education and Communication Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
| | - Kim E van Nieuwenhuizen
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Frank Willem Jansen
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Anne C van der Eijk
- Operation Room Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - John J van den Dobbelsteen
- Biomedical Engineering Department, Technical University of Delft, Mekelweg 5, 2628 CD, Delft, the Netherlands
- Gynecology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
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Impact of WALANT Hand Surgery in a Secondary Care Hospital in Spain. Benefits to the Patient and the Health System. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 5:73-79. [PMID: 36704374 PMCID: PMC9870812 DOI: 10.1016/j.jhsg.2022.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/04/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study is to compare patient benefits and economic costs of hand surgeries using the wide-awake local anesthesia no tourniquet (WALANT) technique versus a conventional major outpatient suite and review outcomes and complications in a series of cases of patients operated on using the WALANT technique. Methods A prospective cohort study was first conducted comparing 150 cases of ambulatory hand surgery (carpal tunnel syndrome and trigger finger) using the WALANT technique and not requiring an operating room setting with 150 cases of outpatient surgery performed in an operating room involving a preoperative evaluation and the use of sedation and tourniquet. Preoperative, intraoperative, and postoperative pain was monitored, and days requiring postoperative analgesia were recorded. The resources and costs were evaluated. and patient satisfaction was assessed using a specific survey.Subsequently, 580 patient medical records were retrospectively reviewed, including 419 carpal tunnel syndrome and 197 trigger finger interventions (616 WALANT surgeries). Results Intraoperative pain was equivalent for both groups, and postoperative pain was significantly lower in the WALANT group, with a reduced need for analgesics. Satisfaction was greater for the local anesthesia group. The use of personnel resources and hospital materials was reduced in the WALANT group, with a total estimated cost savings of 1.019 USD per patient.There were no complications related to the WALANT technique and the lidocaine and adrenaline combination. We found a complication rate of 5.58%, and, in line with the literature, most complications were minor, managed conservatively, and not related to the anesthetic technique. Conclusions Procedures such as carpal tunnel and trigger finger surgeries can be safely performed using wide-awake surgery. Patient satisfaction is higher than with the conventional procedure performed in the operating room. Pain control is excellent, especially during the postoperative period. Clinical relevance Hand surgery patients benefit from the WALANT technique in terms of comfort and timeliness because there is no need for preoperative tests or evaluations. In addition, it represents significant savings in hospital resources. In our case series, complications were in line with those previously reported with other anesthetic techniques.
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Contributing Factors to Operating Room Delays Identified from an Electronic Health Record: A Retrospective Study. Anesthesiol Res Pract 2022; 2022:8635454. [PMID: 36147900 PMCID: PMC9489409 DOI: 10.1155/2022/8635454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 11/24/2022] Open
Abstract
The operating room (OR) is considered a major cost center and revenue generator for hospitals. Multiple factors contribute to OR delays and impact patient safety, patient satisfaction scores, and hospital financial performance. Reducing OR delays allows better utilization of OR resources and staffing and improves patient satisfaction while decreasing operating costs. Accurate scheduling can be the basis to achieve these goals. The objective of this initial study was to identify factors not normally documented in the electronic health record (EHR) that may contribute to or be indicators of OR delays. Materials and Methods. A retrospective data analysis was performed analyzing 67,812 OR cases from 12 surgical specialties at a small university medical center from 2010 through the first quarter of 2017. Data from the hospital's EHR were exported and subjected to statistical analysis using Statistical Analysis System (SAS) software (SAS Institute, Cary, NC). Results. Statistical analysis of the extracted EHR data revealed factors that were associated with OR delays including, surgical specialty, preoperative assessment testing, patient body mass index, American Society of Anesthesiologists (ASA) physical status classification, daily procedure count, and calendar year. Conclusions. Delays hurt OR efficiency on many levels. Identifying those factors may reduce delays and better accommodate the needs of surgeons, staff, and patients thereby leading to improved patient's outcomes and patient satisfaction. Reducing delays can decrease operating costs and improve the financial position of the operating theater as well as that of the hospital. Anesthesiology teams can play a key role in identifying factors that cause delays and implementing mitigating efficiencies.
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Pandit JJ, Ramachandran SK, Pandit M. The effect of overlapping surgical scheduling on operating theatre productivity: a narrative review. Anaesthesia 2022; 77:1030-1038. [PMID: 35863080 PMCID: PMC9543504 DOI: 10.1111/anae.15797] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 01/11/2023]
Abstract
This article reviews the background to overlapping surgery, in which a single senior surgeon operates across two parallel operating theatres; anaesthesia is induced and surgery commenced by junior surgeons in the second operating theatre while the lead surgeon completes the operation in the first. We assess whether there is any theoretical basis to expect increased productivity in terms of number of operations completed. A review of observational studies found that while there is a perception of increased surgical output for one surgeon, there is no evidence of increased productivity compared with two surgeons working in parallel. There is potential for overlapping surgery to have some positive impact in situations where turnover times between cases are long, operations are short (<2 h) and where 'critical portions' of surgery constitute about half of the total operation time. However, any advantages must be balanced against safety, ethical and training concerns.
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Affiliation(s)
- J. J. Pandit
- University of OxfordUK,Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - S. K. Ramachandran
- Department of AnesthesiaBeth Israel Deaconess Medical CenterBostonMAUSA,Harvard Medical SchoolBostonMAUSA
| | - M. Pandit
- Oxford University Hospitals NHS Foundation TrustOxfordUK
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Elgar G, Smiley P, Smiley A, Feingold C, Latifi R. Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169905. [PMID: 36011537 PMCID: PMC9408669 DOI: 10.3390/ijerph19169905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 05/20/2023]
Abstract
Background: In the United States, ileus accounts for USD 750 million of healthcare expenditures annually and significantly contributes to morbidity and mortality. Despite its significance, the complete picture of mortality risk factors for these patients have yet to be fully elucidated; therefore, the aim of this study is to identify mortality risk factors in patients emergently admitted with paralytic ileus. Methods: Adult and elderly patients emergently admitted with paralytic ileus between 2005−2014 were investigated using the National Inpatient Sample Database. Clinical outcomes, therapeutic management, demographics and comorbidities were collected. Associations between mortality and all other variables were established via univariable and multivariable logistic regression models. Results: A total of 81,674 patients were included, of which 45.2% were adults, 54.8% elderly patients, 45.8% male and 54.2% female. The average adult and elderly ages were 48.3 and 78.8 years, respectively. Elderly patients displayed a significantly (p < 0.01) higher mortality rate (3.0%) than adults (0.7%). The final multivariable logistic regression model showed that for every one-day delay in operation, the odds of mortality for adult and elderly patients increased by 4.1% (p = 0.002) and 3.2% (p = 0.014), respectively. Every additional year of age corresponded to 3.8% and 2.6% increases in mortality for operatively managed adult (p = 0.026) and elderly (p = 0.015) patients. Similarly, non-operatively treated adult and elderly patients displayed associations between mortality and advanced age (p = 0.001). The modified frailty index exhibited associations with mortality in operatively treated adults, conservatively managed adults and conservatively managed elderly patients (p = 0.001). Every additional day of hospitalization increased the odds of mortality in non-operative adult and elderly patients by 7.6% and 5.8%, respectively. Female sex correlated to lower mortality rates in non-operatively managed adult patients (odds ratio = 0.71, p = 0.028). Undergoing invasive diagnostic procedures in non-operatively managed elderly patients related to reduced mortality (odds ratio = 0.78, p = 0.026). Conclusions: Patients emergently admitted for paralytic ileus with increased hospital length of stay, longer time to operation, advanced age or higher modified frailty index displayed higher mortality rates. Female sex and invasive diagnostic procedures were negatively correlated with death in nonoperatively managed patients with paralytic ileus.
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Affiliation(s)
- Guy Elgar
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Parsa Smiley
- School of Engineering, University of Massachusetts at Amherst, Amherst, MA 01003, USA
| | - Abbas Smiley
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
- Correspondence: (A.S.); (R.L.)
| | - Cailan Feingold
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Rifat Latifi
- Minister of Health, 10000 Pristina, Kosovo
- School of Medicine, University of Arizona, Tucson, AZ 85721, USA
- Correspondence: (A.S.); (R.L.)
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Waloejo CS, Sulistiawan SS, Semedi BP, Dzakiyah AZ, Stella MA, Ikhromi N, Nahyani , Endriani E, Rahardjo E, Pandin MGR. The Anesthetic Techniques for Earthquake Victims in Indonesia. Open Access Emerg Med 2022; 14:77-84. [PMID: 35250317 PMCID: PMC8888197 DOI: 10.2147/oaem.s331344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/10/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction In Lombok, three-large magnitude earthquakes occurred in July 2018 and caused major losses: 564 victims died, 1684 were injured, 445,343 people became refugees, and 215,628 houses were damaged. It damaged 408 health facilities, consisting of 89 public health centers, 13 hospitals, 174 auxiliary public health centers, 132 village health posts. Aim The purpose of this study is to describe the anesthetic techniques that were used to treat earthquake victims. Methods This study was a descriptive cross-sectional study that was conducted by collecting total sampling from all earthquake victims treated in the emergency room (ER) of the regional public hospital (RSUD NTB) on August 6th and 7th, 2018, and all victims who underwent surgery during August 5th–25th, 2018. The data that were collected were surgery type, anesthetic techniques, and anesthesia drugs that were used. Results The results show that the highest number of patients were treated in the ER during the first seven days after the earthquake and that this number then decreased over several weeks. The majority of patients treated were trauma patients who needed orthopedic surgery. General anesthesia was more widely used than regional anesthesia, but the difference was not significant. The most commonly used regional anesthetic was lidocaine hyperbaric 75–100 mg and clonidine 30–50 mcg combination. Regional anesthesia techniques have better results in cases of lower limb injury, but it is difficult to be applied in earthquake victims who present with complex injuries and limited resources.
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Mansour D, Sayeed Z, Padela MT, McCarty S, Tonnos F, Silas D, Mostafa G, Yassir WK. Accountable Operating Room Teams. Orthopedics 2021; 44:e463-e470. [PMID: 34292838 DOI: 10.3928/01477447-20210618-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With Medicare reimbursement diminishing and the aging population consuming more health care, hospitals continue to push for reforms to improve the efficiency of health care delivery, decrease consumption, and elevate the quality of care. Operating rooms command a large share of hospital resources but are also major revenue generators. Surgical care has evolved to become more efficient and accountable. Defining the characteristics of an accountable operating room team has been more elusive and inconsistent. This review defines the characteristics of accountable operating room teams and recommends measures by which to evaluate them. [Orthopedics. 2021;44(4):e463-e470.].
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Craig JE, Martin-Krajewski CA, Bledsoe JM, Wensink LJ, Crawford NS, Eberhardt AM, Grottke KL, Helmers RA. Regional Specialty Surgical Practice Efficiencies Gained as a Result of COVID-19. Mayo Clin Proc Innov Qual Outcomes 2021; 5:693-699. [PMID: 34151194 PMCID: PMC8205250 DOI: 10.1016/j.mayocpiqo.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To identify opportunities for discontinuing elective and nonemergency surgical cases in a regional surgical practice in response to coronavirus disease 2019 (COVID-19). Patients and Methods COVID-19 began to affect surgical practices across the United States in March 2020. On March 17, 2020, all elective and nonemergency surgical care was deferred to prepare the Mayo Clinic Health System sites in northwestern Wisconsin for an anticipated surge in patients with COVID-19. When the decision was made to reactivate the surgical practice, several major structural and operational changes were made to the regional surgical practice to optimize efficiencies. Results The structural and operational changes implemented during reactivation resulted in improved utilization of surgical resources including improvement in operating room (OR) block utilization, increased available OR time, and increased case volumes. Conclusion Surgical and procedural leaders should consider a limited-time deferral of elective surgical cases to implement widespread OR efficiency strategies. The time selected for deferral of surgical cases should target a period of historically low surgical volume to minimize disruption to patient care and impact on overall OR functions.
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A Surgeon Badge or Text Message Sign-in Intervention Improves Operating Room Start Efficiency. J Surg Res 2021; 264:129-137. [PMID: 33831600 DOI: 10.1016/j.jss.2021.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/25/2021] [Accepted: 02/27/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Operating room (OR) efficiency, often measured by first case on-time start (FCOTS) percentage, is an important driver of perioperative team morale and the financial success of a hospital. MATERIALS AND METHODS In this quasi-experimental study of elective surgical procedures at a single tertiary academic hospital, an intervention requiring attending surgeon attestation of availability via SMS text message or identification badge swipe was implemented. Key measures of OR efficiency were compared before and after the change. RESULTS FCOTS percentage increased from 61.6% to 66.9% after the intervention (P = 0.01). After adjusting for patient and procedural characteristics, postintervention period remained associated with an increased odds of an on-time start (odds ratio 1.29, P = 0.01). Additionally, procedural start times from the pre- to postintervention period were significantly improved (-0.08 min/day, P = 0.009). CONCLUSIONS Implementation of an attending surgeon text or badge sign-in process was associated with improved FCOTS percentage and earlier procedure start times.
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Garba DL, Asher AM, Loewenstein J, Quinsey C. Does communication between neurosurgeons and anesthesiologists improve preoperative efficiency? Clin Neurol Neurosurg 2021; 201:106461. [PMID: 33508594 DOI: 10.1016/j.clineuro.2020.106461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/02/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Suboptimal communication can lead to preventable preoperative delays. In our study, we aimed to identify factors delaying surgery in the immediate preoperative period. Our outcomes of interest were the anesthesia release to incision time (RIT) and preoperative expectations of neurosurgery and anesthesia providers. Additionally, we introduced new communication goals prior to induction, to examine the impact on preoperative efficiency. METHODS The study is a prospective cohort analysis evaluating communication in the immediate preoperative period. In 42 consecutive cranial neurosurgical cases, a questionnaire was given to neurosurgical and anesthesia providers, and their responses were recorded. Halfway through this study, a formal pre-induction checklist was implemented that included expected duration of surgery, expected blood loss, surgical positioning, and intraoperative medication requirements. RESULTS Comparing the cohorts before and after implementing the checklist, no difference in release to incision time was observed. However, the difference in estimated procedure time was significantly decreased after implementation of the formal pre-induction checklist. Further, there was a trend towards better agreement in estimated blood loss, although results did not achieve statistical significance. These delays all demonstrated a statistically significant decrease after the new communication goals were executed. CONCLUSION While no statistically significant change in release to incision time was uncovered during our study, there was evidence that communication between teams improved after implementation of the checklist. Additionally, we observed less discrepancy in estimated case length and blood loss, suggesting focused communication goals aligned expectations of the neurosurgical and anesthesia teams.
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Affiliation(s)
- Deen L Garba
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Anthony M Asher
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Joshua Loewenstein
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
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15
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Jenny H, Reategui Via Y Rada M, Yesantharao P, Xun H, Redett R, Sacks JM, Yang R. Efficacy of a Novel Intraoperative Engineered Sharps Injury Prevention Device: Pilot Usability and Efficacy Trial. JMIR Perioper Med 2020; 3:e19729. [PMID: 33393914 PMCID: PMC7728410 DOI: 10.2196/19729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/04/2020] [Accepted: 10/26/2020] [Indexed: 01/20/2023] Open
Abstract
Background The American College of Surgeons reports 88,320 intraoperative needlestick injuries (NSIs) per year, resulting in US $376 to US $2456 in costs per NSI. Engineered sharps injury prevention (ESIP) devices protect against NSIs. To our knowledge, no study has been published to date to demonstrate clinical effectiveness of an intraoperative ESIP device. Operative Armour is a wearable arm cuff that can be donned during surgical closure to allow surgeons to keep a suture pack and sharps protection container on their forearm. Objective We characterize Operative Armour’s ESIP device effectiveness in a tertiary hospital, hypothesizing that this device will decrease NSI risk by decreasing behaviors associated with NSIs: needle passing and handling. Methods A prospective case-control study was conducted with institutional review board quality improvement designation in which authors observed skin closures of plastic surgery procedures. To ensure accuracy, one surgeon was observed at a time. Control surgeries were purely observational; intervention cases involved surgeon use of the device during skin closure. Outcomes of interest included needle passing, needle handling, lost needles, and loaded waiting needles. Results Surgeons were observed in 50 control and 50 intervention cases. Operative Armour eliminated needle passing during skin closure. One NSI occurred in one control case; no NSIs were observed in intervention cases (P=.36). The mean number of loaded and unprotected waiting needles was also significantly decreased in the intervention group from 2.3 to 0.2 (P<.001). Furthermore, a multivariable linear regression established that Operative Armour significantly decreased the number of needle adjustments by hand per stitch observed (F4, 21.68=3.72; P=.01). In fact, needle adjustments by hand decreased overall (1 adjustment per 10 stitches vs 1 adjustment per 5 stitches, P=.004), and adjustments occurred half as frequently with use of Operative Armour in free flap reconstruction (1 adjustment per 10 stitches vs 1 adjustment per 5 stitches, P=.03) and a quarter as frequently in other breast reconstruction cases such as mastopexy (1 adjustment per 20 stitches vs 1 adjustment per 5 stitches, P=.002). Conclusions Operative Armour effectively functions as an ESIP device by decreasing intraoperative needle passing and handling. Although sample size prohibits demonstrating a decrease in NSIs during observed cases, by decreasing behaviors that drive NSI risk, we anticipate an associated decrease in NSIs with use of the device.
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Affiliation(s)
- Hillary Jenny
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | | | - Pooja Yesantharao
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Helen Xun
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Richard Redett
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Justin Michael Sacks
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Robin Yang
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
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16
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Okeke CJ, Okorie CO, Ojewola RW, Omoke NI, Obi AO, Egwu AN, Onyebum OV. Delay of Surgery Start Time: Experience in a Nigerian Teaching Hospital. Niger J Surg 2020; 26:110-116. [PMID: 33223807 PMCID: PMC7659763 DOI: 10.4103/njs.njs_61_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/24/2020] [Accepted: 03/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Operating room delay has multiple negative effects on the patients, surgical team, and the hospital system. Maximum utilization of the operating room requires on-time knife on the skin and efficient turnover. Knowledge of the reasons for the delay will form a basis toward proffering solutions. Patients and Methods: This was a prospective study of all consecutive elective cases done over a 15-month period from January 2016 to March 2017. Using our departmental protocol that “knife on skin” for the first elective case should be 8.00am, the delay was defined as a surgery starting later than 8.00am for the first cases while the interval between the cases of >30 min for the knife on the skin was used for subsequent cases. Reasons for delay in all cases of delay were documented. The prevalence and causes of the delays were analyzed. P < 0.05 was considered statistically significant. Results: Of 1178 surgeries performed during the period of study, 1170 (99.3%) of cases were delayed. The mean delay time was 151 min for all cases. First on the list had a longer delay time than others; 198.9 min versus 108.5 min (P = 0.000). Delay in the first cases accounted for 47.5% of all delayed cases. Overall, patient-related factor was the most common cause of delay (31.3%) followed in descending order by surgeon-related factor (28.5%) and hospital-related factor (26.2%). Patient-related factors accounted for 43.2% of first-case delays. Conclusion: Delays encountered in this study were multifactorial and are preventable. Efforts should be directed at these different causes of delay in the theater to mitigate these delays and improve productivity.
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Affiliation(s)
- Chike John Okeke
- Department of Surgery, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Surulere, Lagos, Nigeria
| | - Chukwudi Ogonnaya Okorie
- Department of Surgery, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,Department of Surgery, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Rufus Wale Ojewola
- Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Surulere, Lagos, Nigeria.,Department of Surgery, College of Medicine, University of Lagos, Idi-Araba, Surulere, Lagos, Nigeria
| | - Njoku Isaac Omoke
- Department of Surgery, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,Department of Surgery, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Anselm Okwudili Obi
- Department of Surgery, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,Department of Surgery, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Agama Nnachi Egwu
- Department of Surgery, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,Department of Surgery, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
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17
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Mosadeghrad AM, Afshari M. Quality management effects on operating theater's productivity: a participatory action research. TQM JOURNAL 2020. [DOI: 10.1108/tqm-04-2020-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe operating theater (OT) is resource-intensive, costly and assuring its productivity is a high priority. This study aimed to examine a quality management model's effects on a hospital's OT productivity.Design/methodology/approachThe participatory action research approach was used for the intervention. A multidisciplinary quality improvement team was formed. The team improved OT operational processes using an eight-step quality management model. OT’s key performance indicators such as surgical cases, surgical cancellation, bill deductions, successful cardiopulmonary resuscitation, patients' complaints and employees' job satisfaction were collected before the intervention and compared with those of after intervention to determine the efficacy of the quality management model.FindingsApplying a quality management strategy increased surgical patients' number by 14.96%, reduced surgery operations cancellation by 14.6 %, and decreased bill deduction by 44.9%. Besides, successful cardiopulmonary resuscitation increased by 21.17%, patients' complaints reduced by 61.5% and, finally, staff satisfaction increased by 15.6 %. Improved OT productivity resulted in improved financial performance. As a result, the OT revenue has risen by 68.8%.Originality/valueThis study highlights that implementing the right quality management model properly enhances hospitals' productivity. It also offers suggestions on how to implement a quality management model successfully in a hospital setting.
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18
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Peripheral nerve blockade and novel analgesic modalities for ambulatory anesthesia. Curr Opin Anaesthesiol 2020; 33:760-767. [DOI: 10.1097/aco.0000000000000928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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19
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Franceschi D, Suarez MM, Ruiz JW, Seo D, Merchant NB. A Novel Interdisciplinary Iterative Approach for Optimizing the Electronic Health Record to Improve Perioperative Efficiency. Ann Surg 2020; 272:669-675. [PMID: 32932324 DOI: 10.1097/sla.0000000000004347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE We present a holistic perioperative optimization approach led by a CI team with the goal to optimize the workflow within our EHR, improve operative room metrics and user satisfaction. SUMMARY OF BACKGROUND DATA The EHR has become integral to perioperative care. Many approaches are utilized to improve performance including systems-based approaches, process redesign, lean methodology, checklists, root cause analysis, and parallel processing. Although most reports describe strategies improving day or surgery productivity, few include perioperative interventions to improve efficiencies. METHODS An interdisciplinary CI team consisting of clinicians, informatics specialists, and analysts spent 6 weeks assessing users and optimizing all perioperative areas (scheduling, day of surgery, postop discharge/admission). Elbow-to-elbow retraining and simultaneous content development was performed utilizing an Agile workflow process optimization with the Scrum framework. This iterative approach averaged 1 week from build to change implementation. Pre/post optimization surveys were sent. RESULTS Two hundred forty-two perioperative enhancements were completed. While most impacted documentation, all areas were enhanced including billing, reporting, registration, device integration, scheduling, central supply, and so on. FCOTS improved from <70% to >85% and total delay was halved. These parameters were consistently sustained for over 1 year after the 6-week optimization. While only 5% of pre-optimization users agreed to proficiency in the EHR system, this improved to 70% post-optimization. Furthermore, EHR confidence and acceptance improved from 40% to 90%. CONCLUSIONS To improve workflow efficiency, all who contribute to the perioperative process must be assessed. This IT driven initiative resulted in improved FCOTS, perioperative workflows, and user satisfaction.
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Affiliation(s)
- Dido Franceschi
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Maritza M Suarez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Jose W Ruiz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
| | - David Seo
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Nipun B Merchant
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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20
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Matsuzaki S, Bonnin M, Fournet-Fayard A, Bazin JE, Botchorishvili R. Effects of Low Intraperitoneal Pressure on Quality of Postoperative Recovery after Laparoscopic Surgery for Genital Prolapse in Elderly Patients Aged 75 Years or Older. J Minim Invasive Gynecol 2020; 28:1072-1078.e3. [PMID: 32979535 DOI: 10.1016/j.jmig.2020.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/04/2020] [Accepted: 09/19/2020] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE Previous clinical trials for laparoscopic surgery have included few elderly patients aged ≥75 years. We aimed to evaluate the quality of postoperative recovery after laparoscopic surgery using low intraperitoneal pressure (IPP) (6 mm Hg) and warmed, humidified carbon dioxide gas for genital prolapse in elderly patients aged ≥75 years. DESIGN Prospective consecutive case series. SETTING University hospital. PATIENTS Consecutive patients (n = 30) aged ≥75 years planning to undergo laparoscopic surgery for genital prolapse by the same surgeon were recruited from October 2016 through December 2019. INTERVENTIONS Laparoscopic promontofixation for the treatment of genital prolapse was performed using low IPP and warmed, humidified carbon dioxide gas. When a promontory could not be easily identified, laparoscopic pectopexy was alternatively performed. MEASUREMENTS AND MAIN RESULTS The primary outcome was the Quality of Recovery-40 (QoR-40) score at 24 hours postoperatively. The secondary outcomes were postoperative pain using a 100-mm visual analog scale and the length of hospital stay after surgery (LHSS). For the global QoR-40 score and for 4 dimensions of the QoR-40, "emotional state," "physical comfort," "psychologic support," and "pain," no differences were observed between the baseline score and the score at 24 hours. The score for the "physical independence" dimension at 24 hours was significantly lower than the baseline score (p <.001). No patient had visual analog scale pain scores >30 out of 100 at 12 hours or later. LHSS was <48 hours in 22 patients (73.3%) and <72 hours in 8 patients (26.7%). Multivariable analysis showed that the odds of an LHSS >48 hours were more than 8 times higher in patients who were discharged from the operating room in the afternoon compared with those with a morning discharge. CONCLUSION The use of a low IPP is feasible, safe, and has clinical benefits for elderly patients aged ≥75 years who undergo laparoscopic surgery for genital prolapse.
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Affiliation(s)
- Sachiko Matsuzaki
- Department of Gynecologic Surgery, CHU Clermont-Ferrand (Drs. Matsuzaki and Botchorishvili); UMR6602, CNRS/UCA/SIGMA, Institute Pascal, University of Clermont Auvergne (Drs. Matsuzaki and Botchorishvili).
| | - Martine Bonnin
- Department of Perioperative Medicine, CHU Clermont-Ferrand (Drs. Bonnin, Fournet-Fayard, and Bazin), Clermont-Ferrand, France
| | - Aurelie Fournet-Fayard
- Department of Perioperative Medicine, CHU Clermont-Ferrand (Drs. Bonnin, Fournet-Fayard, and Bazin), Clermont-Ferrand, France
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, CHU Clermont-Ferrand (Drs. Bonnin, Fournet-Fayard, and Bazin), Clermont-Ferrand, France
| | - Revaz Botchorishvili
- Department of Gynecologic Surgery, CHU Clermont-Ferrand (Drs. Matsuzaki and Botchorishvili); UMR6602, CNRS/UCA/SIGMA, Institute Pascal, University of Clermont Auvergne (Drs. Matsuzaki and Botchorishvili)
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21
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Milone MT, Hacquebord H, Catalano LW, Glickel SZ, Hacquebord JH. Preparatory Time-Related Hand Surgery Operating Room Inefficiency: A Systems Analysis. Hand (N Y) 2020; 15:659-665. [PMID: 30808238 PMCID: PMC7543209 DOI: 10.1177/1558944719831333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: No study exists on preparatory time-from patient's entrance into the operating room to skin incision-and its role in hand surgery operating room inefficiency. The purpose of this study was to investigate the length and variability of preparatory time and assess the relationship between several variables and preparatory time. Methods: Consecutive upper extremity cases performed for a period of 1 month by hand surgeons were reviewed at 3 surgical sites. Preparatory time was compared across locations. Cases at one location were further analyzed to assess the relationship between preparatory time and several variables. Both traditional statistical methods and Shewhart control charts, a quality control tool, were used for data analysis. Results: A total of 288 cases were performed. The mean preparatory times at the 3 sites were 25.1, 25.7, and 20.7 minutes, respectivley. Aggregated preparatory time averaged 24.4 (range 7-61) minutes, was 75% the length of the surgical time, and accounted for 34% of total operating room time. Control charts confirmed substantial variability at all locations, signifying a poorly defined process. At a single site, where 189 cases were performed by 14 different surgeons, there was no difference in preparatory time by case type, American Society of Anesthesiologists status, or case start time. Preparatory time varied by surgeon and anesthesia type. Conclusions: Preparatory time was found to be a source of inefficiency, independent of the surgical site. Control charts reinforced large variations, signifying a poorly designed process. Surgeon seemingly plays an important, albeit likely indirect, role. Efforts to improve operating room workflow should include preparatory time.
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Affiliation(s)
- Michael T. Milone
- New York University Langone Orthopedic Hospital, New York City, USA,Michael T. Milone, New York University Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY 10003, USA.
| | | | | | | | - Jacques H. Hacquebord
- New York University Langone Orthopedic Hospital, New York City, USA,New York University Langone Medical Center, New York City, USA
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22
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Marlborough F, Anderson I, Allison K. Maximising efficiency in plastic surgery local anaesthetic lists. J Plast Reconstr Aesthet Surg 2020; 73:e1-e3. [PMID: 32586756 DOI: 10.1016/j.bjps.2020.05.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- F Marlborough
- Plastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom.
| | - I Anderson
- Plastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom
| | - K Allison
- Plastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom
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23
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Prozessoptimierung im operativen Bereich. Unfallchirurg 2020; 123:517-525. [DOI: 10.1007/s00113-020-00810-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Tyerman Z, Mehaffey JH, Hawkins RB, Diop M, Carroll ND, Howell AM, Kern JA, Ailawadi G, Teman N. Nightly Preoperative Huddle Email Improves Perioperative Efficiency. Ann Thorac Surg 2020; 109:445-451. [DOI: 10.1016/j.athoracsur.2019.05.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 05/08/2019] [Accepted: 05/28/2019] [Indexed: 02/01/2023]
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Discovering the barriers to efficient robotic operating room turnover time: perceptions vs. reality. J Robot Surg 2020; 14:717-724. [PMID: 31933120 DOI: 10.1007/s11701-020-01045-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
Turnover time (TOT) has remained the subject of numerous research articles and operating room (OR) committee discussions. Inefficiencies associated with TOT are multiplied when complex technology, such as surgical robots, is involved. Using a human factors approach, this study investigated impediments to efficient robotic TOT and team members' perceptions surrounding this topic. Researchers observed 20 robotic turnovers over 2 months at a tertiary hospital. TOT, cleaning time, number of staff present, bed set-up time, instrument set-up time and any major delays were recorded. Additionally, 79 OR team members completed a questionnaire regarding perceptions of OR turnover. Average TOT was 72 min (s, 24 min). Overall, cleaning required the most time (average of 27.4 min, 37.96% of TOT), followed by instrument set-up (15.4 min, 21.34% of TOT) and RN retrieval of the patient from pre-op (12 min, 17.72% of TOT). OR team members estimated that turnovers require 60.36 min. Physicians believed the greatest contributor to TOT was "time to set up the OR", while OR staff rated "instrument availability" as the greatest issue, both of which were inaccurate. OR team members' perceptions of robotic TOT and contributing factors were different from reality based on observed contributors. Data demonstrated several areas of opportunity for process improvement. These data can be used to guide the implementation of targeted interventions to improve TOT efficiency.
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Far-Riera A, Pérez-Uribarri C, Sánchez Jiménez M, Esteras Serrano M, Rapariz González J, Ruiz Hernández I. Prospective study on the application of a WALANT circuit. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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27
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Pepley DF, Chen HE, Tang Y, Adhikary SD, Miller SR, Moore JZ. Low-Cost Haptic Simulation Using Material Fracture. IEEE TRANSACTIONS ON HAPTICS 2019; 12:563-570. [PMID: 31056520 PMCID: PMC6944059 DOI: 10.1109/toh.2019.2914441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Medical simulation training is widely used to effectively train for invasive medical procedures such as peripheral nerve blocks. Traditionally, accurate haptic training relies on expensive cadavers, manikins, or advanced haptic robots. Proposed herein is a novel concept for haptic training called the low-cost haptic force needle insertion simulator (LCNIS), which uses material fracture inside disposable cartridges to accurately replicate the force of inserting a needle into tissue. Cadaver and material fracture experiments were performed to develop and determine the accuracy of the LCNIS. The material testing showed that polycarbonate had the highest maximum needle puncture force of the materials tested, 9.85 N, and that fluorinated ethylene propylene had the lowest maximum puncture force, 0.84 N. The cadaver results showed that the error between the three peak forces in a cadaver and a cadaver mimicking cartridge was 1.00 N, 0.01 N, and 1.54 N. The standard deviation of these peaks was 0.60 N, 0.55 N, and 0.41 N. This novel method of haptic simulation can easily be adapted to recreate any type of force and, therefore, could be utilized to train for a wide variety of medical procedures.
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Far-Riera AM, Pérez-Uribarri C, Sánchez Jiménez M, Esteras Serrano MJ, Rapariz González JM, Ruiz Hernández IM. Prospective study on the application of a WALANT circuit for surgery of tunnel carpal syndrome and trigger finger. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:400-407. [PMID: 31471242 DOI: 10.1016/j.recot.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate benefits for the patient and the economic impact for the implementation of a wide awake local anesthesia no tourniquet (WALANT) hand surgery compared to traditional major outpatient circuit. METHODS A prospective cohort study was planned comparing 150 cases of ambulatory hand surgery (carpal tunnel and trigger finger) using WALANT technique intervention out from the operating room; with another 150 which underwent intervention, outpatient setting, with preoperative evaluation, sedation and tourniquet, in the operation room. Preoperative, intraoperative and postoperative pain was monitored, as well as the days that required postoperative analgesia.The resources used and costs were evaluated. Satisfaction was evaluated using a specific survey. RESULTS The pain during the surgery was equivalent for both groups and was significantly lower postoperatively for the WALANT group, with less need for the use of analgesics. Satisfaction was greater for the local anesthesia group. The use of personnel resources and hospital material was less for the WALANT group, with total saving calculated by 1,019€ per patient. CONCLUSIONS Procedures such as carpal tunnel surgery and trigger finger surgery can be safely performed using wide awake surgery. Patient satisfaction is higher to conventional procedure in the operation room. Pain control is excellent, especially during the postoperative period. WALANT technique for hand surgery represents a benefit for the patient in comfort, timeliness and no need for preoperative tests or evaluation. In addition, it represents a significant savings in hospital resources.
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Affiliation(s)
- A M Far-Riera
- Unidad de Cirugía de Mano y extremidad superior, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Son Llàtzer, Palma de Mallorca, España.
| | - C Pérez-Uribarri
- Unidad de Cirugía de Mano y extremidad superior, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Son Llàtzer, Palma de Mallorca, España
| | - M Sánchez Jiménez
- Unidad de Cirugía de Mano y extremidad superior, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Son Llàtzer, Palma de Mallorca, España
| | - M J Esteras Serrano
- Unidad de Cirugía de Mano y extremidad superior, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Son Llàtzer, Palma de Mallorca, España
| | - J M Rapariz González
- Unidad de Cirugía de Mano y extremidad superior, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Son Llàtzer, Palma de Mallorca, España
| | - I M Ruiz Hernández
- Unidad de Cirugía de Mano y extremidad superior, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Son Llàtzer, Palma de Mallorca, España
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Hall BR, Flores LE, Parshall ZS, Shostrom VK, Are C, Reames BN. Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure-targeted analysis. J Surg Oncol 2019; 120:661-669. [PMID: 31292967 DOI: 10.1002/jso.25613] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak. METHODS Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak. RESULTS Of 915 patients included, 83% were male and the median age was 64 years. Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P < .001). Rates of reoperation (64% vs 11%, P < .001) and mortality (8% vs 2%, P = .001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P = .003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P = .019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P = .045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P = .028) were independently associated with anastomotic leak. CONCLUSION Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.
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Affiliation(s)
- Bradley R Hall
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Laura E Flores
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Zachary S Parshall
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Valerie K Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, Nebraska
| | - Chandrakanth Are
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska.,Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bradley N Reames
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska.,Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
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Time-driven activity-based costing to model the utility of parallel induction redesign in high-turnover operating lists. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2019; 7:100355. [PMID: 30770190 DOI: 10.1016/j.hjdsi.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 12/19/2018] [Accepted: 01/28/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Value-based healthcare is strongly advocated to reduce the spiralling rise in healthcare expenditure. Operating room efficiency is an important focus of value-based healthcare delivery due to high costs and associated hospital revenue derived from procedural streams of care. A parallel induction design, utilising induction rooms for anesthetising patients, may improve operating room efficiency and optimise revenue. We used time-driven activity-based costing (TDABC) to model personnel costs for a high-turnover operating list to assess value of parallel induction redesign. METHODS We prospectively captured activity data from high-turnover surgery allocated to induction of anesthesia within the operating room (serial design) or within induction rooms prior to completion of preceding surgery (parallel design). Personnel costs were constructed using TDABC following assignment of a case-mix that integrated our activity data. This was contrasted against procedural revenue to assess value of projected case throughput. RESULTS Under a parallel induction design, projected operating list duration was reduced by 55 min at marginal increase (1.6%) in personnel costs as assessed by TDABC. This could facilitate an additional short duration surgical case (e.g. Wide Local Excision, with potential additional revenue of $2818 per day and $0.73 M per annum per operating room. CONCLUSIONS Parallel induction design reduces non-operative time at minimal increase in personnel costs for all-day, high turnover surgery. An additional short duration surgical case is likely feasible under this model and represents a value investment with minimal requirement for additional personnel resources. IMPLICATIONS A parallel induction design, within the constraints of finite healthcare funding, may help alleviate some of the global increase in demand for surgical capacity that accompanies an expanding and aging population.
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Padegimas EM, Hendy BA, Chan WW, Lawrence C, Cox RM, Namdari S, Lazarus MD, Williams GR, Ramsey ML, Horneff JG. The effect of an orthopedic specialty hospital on operating room efficiency in shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:15-21. [PMID: 30241986 DOI: 10.1016/j.jse.2018.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/19/2018] [Accepted: 06/23/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Operating room (OR) time is a major cost to the health care system. Therefore, increasing OR efficiency to save time may be a cost-saving tool. This study analyzed OR efficiency in shoulder arthroplasty at an orthopedic specialty hospital (OSH) and a tertiary referral center (TRC). METHODS All primary shoulder arthroplasties performed at our OSH and TRC were identified (2013-2015). Manually matched cohorts from the OSH and TRC were compared for OR times. Three times (minutes) were recorded: anesthesia preparation time (APT; patient in room to skin incision), surgical time (ST; skin incision to skin closed), conclusion time (CT; skin closed to patient out of room). RESULTS There were 136 primary shoulder arthroplasties performed at the OSH and matched with 136 at the TRC. OSH and TRC patients were similar in age (P = .95), body mass index (P = .97), Charlson Comorbidity Index (P = 1.000), sex (P = 1.000), procedure (P = 1.000), insurance status (P = .714), discharge destination (P = .287), and diagnoses (P = .354). These matched populations had similar ST (OSH: 110.0 ± 26.6 minutes, TRC: 113.4 ± 28.7 minutes; P = .307). APT (39.2 ± 8.0 minutes) and CT (7.6 ± 3.8 minutes) were shorter in the OSH patients than APT (46.3 ± 8.8 minutes; P < .001) and CT (11.2 ± 4.7 minutes; P < .001) in TRC patients. Total nonoperative time (sum of APT and CT) at the OSH (46.8 ± 8.9 minutes) was shorter than at the TRC (57.5 ± 10.4 minutes; P < .001). CONCLUSIONS Despite similar patient populations and case complexity, the OR efficiency at an OSH was superior to a TRC. Further analysis is needed to determine the financial implications of this superior OR efficiency.
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Affiliation(s)
- Eric M Padegimas
- Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Benjamin A Hendy
- Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Wayne W Chan
- Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Cassandra Lawrence
- Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Ryan M Cox
- Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Surena Namdari
- Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Mark D Lazarus
- Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Gerald R Williams
- Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Matthew L Ramsey
- Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - John G Horneff
- Division of Shoulder and Elbow Surgery, The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
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Chernov M, Vick A, Ramachandran S, Reddy S, Leyvi G, Delphin E. Perioperative Efficiency vs. Quality of Care - Do We Always Have to Choose? J INVEST SURG 2018; 33:265-270. [PMID: 30212251 DOI: 10.1080/08941939.2018.1492049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: ATTEMPTS to enforce optimization practices for operating room (OR) efficiency are often interpreted as a "pressure for production" which threatens patient safety. The aim of this study is to assess if and how improvements in OR efficiency affect patient safety and thus the quality of care. Methods: In an attempt to optimize OR efficiency, a new OR management approach "Integrated Practice Improvement Solutions" (IPIS) was developed at the Weiler Division of Montefiore Medical Center in 2011. IPIS is a flexible managerial system based on elements of multiple practice improvement methodologies incorporated into an open source framework. It was implemented in 2012. The data presented covers the period from 2012 through 2014 when the system was temporarily discontinued due to administrative restructuring. Data from 2011 was used as a baseline. The impact of IPIS on patient safety and quality of care was assessed based on quality improvement and patient safety (QIPS) Committee reports covering the same period of time. Results: IPIS implementation resulted in an increase in surgical workload by an average of 10.7%, an increase in OR and anesthesia revenues by 18.5% and 6.9%, respectively, and decreases in turnover time by 15% and overtime for the anesthesia staff by 26%. Based on QIPS reports, the total number of complications potentially attributable to "production pressure" was 0.25%, 0.2% and 0.16% in 2012, 2013 and 2014, respectively compared to 0.21% in 2011 (p = 0.56). Conclusions: Gradual implementation of a methodologically structured improvement in OR efficiency has no negative impact on patient safety and quality of care.
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Affiliation(s)
| | - Angela Vick
- Montefiore Medical Center, Anesthesiology, Bronx, NY, USA
| | | | | | - Galina Leyvi
- Montefiore Medical Center, Anesthesiology, Bronx, NY, USA
| | - Ellise Delphin
- Montefiore Medical Center, Anesthesiology, Bronx, NY, USA
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Cirocco WC, Ellison EC. 75 years of the Central Surgical Association: The last quarter century. Surgery 2018; 164:626-639. [PMID: 30093280 DOI: 10.1016/j.surg.2018.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Affiliation(s)
- William C Cirocco
- The Ohio State University, Wexner College of Medicine, Department of Surgery, N711 Doan Hall, 410 West 10th Avenue, Columbus, OH.
| | - E Christopher Ellison
- The Ohio State University, Wexner College of Medicine, Department of Surgery, N711 Doan Hall, 410 West 10th Avenue, Columbus, OH
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Morris AJ, Sanford JA, Damrose EJ, Wald SH, Kadry B, Macario A. Overlapping Surgery: A Case Study in Operating Room Throughput and Efficiency. Anesthesiol Clin 2018; 36:161-176. [PMID: 29759280 DOI: 10.1016/j.anclin.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A keystone of operating room (OR) management is proper OR allocation to optimize access, safety, efficiency, and throughput. Access is important to surgeons, and overlapping surgery may increase patient access to surgeons with specialized skill sets and facilitate the training of medical students, residents, and fellows. Overlapping surgery is commonly performed in academic medical centers, although recent public scrutiny has raised debate about its safety, necessitating monitoring. This article introduces a system to monitor overlapping surgery, providing a surgeon-specific Key Performance Indicator, and discusses overlapping surgery as an approach toward OR management goals of efficiency and throughput.
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Affiliation(s)
- Amanda J Morris
- Department of Anesthesiology, Stanford Health Care, 300 Pasteur Drive H3580, Stanford, CA 94305, USA.
| | - Joseph A Sanford
- Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205, USA
| | - Edward J Damrose
- Division of Laryngology, Stanford Health Care, 801 Welch Road, Stanford, CA 94305, USA
| | - Samuel H Wald
- Department of Anesthesiology, Stanford Health Care, 300 Pasteur Drive H3580, Stanford, CA 94305, USA
| | - Bassam Kadry
- Department of Anesthesiology, Stanford Health Care, 300 Pasteur Drive H3580, Stanford, CA 94305, USA
| | - Alex Macario
- Department of Anesthesiology, Stanford Health Care, 300 Pasteur Drive H3580, Stanford, CA 94305, USA
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Coffey C, Cho ES, Wei E, Luu A, Ho M, Amaya R, Pecson M, Dalton FV, Kahaku D, Spellberg B, Sener SF. Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center. Am J Surg 2018; 216:194-201. [PMID: 29803501 DOI: 10.1016/j.amjsurg.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/29/2018] [Accepted: 05/04/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Delays in first cases contribute to multiple operating room (OR) inefficiencies and decreases in OR productivity. METHODS Lean process improvement methods were used to redesign the existing workflow for elective first cases of the day in a large, urban, public hospital. First case start times were prospectively recorded from May 2, 2016 through December 29, 2017. RESULTS Data from 415 operating days were examined, 86 days prior to, 35 days during, and 294 days after implementation of interventions in the pre-operative holding area. During this time, of 23,891 operations performed, 14,981 were elective procedures, 5963 (39.8%) of which were first cases of the day. The mean rate of elective first case on-time starts per week went from 23.5% before and during to 73.0% after implementation of lean interventions (p < 0.0000001). CONCLUSIONS Implementation of lean interventions in the pre-operative holding area was associated with significantly improved rates of elective first case on-time starts.
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Affiliation(s)
- Charles Coffey
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Edward S Cho
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Eric Wei
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Allison Luu
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Maria Ho
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Rodolfo Amaya
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Anesthesiology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Marie Pecson
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Florence V Dalton
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Deborah Kahaku
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Brad Spellberg
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Stephen F Sener
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
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Turnbull GS, Hakimi M, McLauchlan GJ. Trauma theatre productivity - Does the individual surgeon, anaesthetist or consultant presence matter? Injury 2018; 49:969-974. [PMID: 29455911 DOI: 10.1016/j.injury.2018.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/27/2018] [Accepted: 02/09/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION With rising NHS clinical and financial demands, improving theatre efficiency is essential to maintain quality of patient care. Consistent teams and consultant presence have been shown to improve outcomes and productivity in elective orthopaedic surgery. The aim of this study was to investigate the impact on trauma theatre productivity of different surgeons and anaesthetists working together in a Major Trauma Centre. The influence of consultant presence and weekend operating on productivity was also considered. METHODS Data relating to a single orthopaedic trauma theatre was gathered retrospectively for a two-year period. Variables including orthopaedic and anaesthetic consultant presence, number and complexity of operations performed and procedure start times were collected for daily trauma lists. Individual anaesthetic and orthopaedic consultants were compared by productivity outcomes. The impact of surgeons operating more frequently with one anaesthetist was also examined. RESULTS Data relating to 2384 patients undergoing a total of 2787 procedures was collected. Orthopaedic consultant presence at the first surgical case (p < 0.05) and for 50% or greater of cases (p < 0.05) lead to higher mean number of cases performed per list and reduced turnaround time. Despite working with a significantly higher number of different consultant anaesthetists (p < 0.001) in year two, the productivity of surgeons as judged by list start time, total cases per list and total operating time was not significantly affected. Significantly earlier start times (p < 0.001) and shorter turnaround times (p < 0.001) at weekends led to maintained productivity despite shorter theatre time. No significant difference in productivity was found when comparing individual anaesthetic and orthopaedic consultants. Productivity was not significantly increased by surgeons operating more frequently with one individual anaesthetist. CONCLUSION In the setting of an acute trauma theatre, orthopaedic consultant presence led to increased productivity. Furthermore, individual surgeon and anaesthetist pairings had no effect on overall productivity. Future efforts to improve productivity should focus on achieving earlier start times, consultant supervision of lists and reduced turnaround times between cases.
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Affiliation(s)
- Gareth S Turnbull
- Clinical Research Fellow, Department of Orthopaedic Surgery, Golden Jubilee National Hospital, Agamemnon St, Clydebank, G81 4DY, United Kingdom.
| | - Mounir Hakimi
- Speciality Trainee Registrar, Department of Trauma and Orthopaedic Surgery, Lancashire Teaching Hospitals, Sharoe Green Lane, Preston, PR2 9HT, United Kingdom
| | - George J McLauchlan
- Consultant Trauma and Orthopaedic Surgeon, Department of Trauma and Orthopaedic Surgery, Lancashire Teaching Hospitals, Sharoe Green Lane, Preston, PR2 9HT, United Kingdom
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Reducing cost and improving operating room efficiency: examination of surgical instrument processing. J Surg Res 2018; 229:15-19. [PMID: 29936982 DOI: 10.1016/j.jss.2018.03.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/04/2018] [Accepted: 03/15/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Operating room efficiency can be compromised because of surgical instrument processing delays. We observed that many instruments in a standardized tray were not routinely used during thyroid and parathyroid surgery at our institution. Our objective was to create a streamlined instrument tray to optimize operative efficiency and cost. MATERIALS AND METHODS Head and neck surgical instrument trays were evaluated by operating room team leaders. Instruments were identified as either necessary or unnecessary based on use during thyroidectomies and parathyroidectomies. The operating room preparation time, tray weights, number of trays, and number of instruments were recorded for the original and new surgical trays. Cost savings were calculated using estimated reprocessing cost of $0.51 per instrument. RESULTS Three of 13 head and neck trays were converted to thyroidectomy and parathyroidectomy trays. The starting head and neck surgical set was reduced from two trays with 98 total instruments to one tray with 36 instruments. Tray weight decreased from 27 pounds to 10 pounds. Tray preparation time decreased from 8 min to 3 min. The new tray saved $31.62 ($49.98 to $18.36) per operation in reprocessing costs. Projected annual savings with hospitalwide implementation is over $28,000.00 for instrument processing alone. Unmeasured hospital savings include decreased instrument wear and replacement frequency, quicker operating room setup, and decreased decontamination costs. CONCLUSIONS Optimizing surgical trays can reduce cost, physical strain, preparation time, decontamination time, and processing times, and streamlining trays is an effective strategy for hospitals to reduce costs and increase operating room efficiency.
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Morris AJ, Mello MM, Sanford JA, Green RB, Wald SH, Kadry B, Macario A. Commentary: How Should Hospitals Respond to Surgeons' Requests to Schedule Overlapping Surgeries? Neurosurgery 2018; 82:E91-E98. [PMID: 29351634 DOI: 10.1093/neuros/nyx627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 12/22/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Amanda J Morris
- Stanford Health Care, Department of Anesthesiology, Stanford, California
| | - Michelle M Mello
- Stanford Law School and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Joseph A Sanford
- University of Arkansas for Medical Sciences, Department of Anesthesiology, Little Rock, Arkansas
| | - Ryan B Green
- John Muir Health - Walnut Creek Medical Center, Department of Anesthesiology, Walnut Creek, California
| | - Samuel H Wald
- Stanford Health Care, Department of Anesthesiology, Stanford, California
| | - Bassam Kadry
- Stanford Health Care, Department of Anesthesiology, Stanford, California
| | - Alex Macario
- Stanford Health Care, Department of Anesthesiology, Stanford, California
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Level of agreement between laboratory and point-of-care prothrombin time in patients after stopping or continuation of acenocoumarol anticoagulation: A comparison of diagnostic accuracy. Eur J Anaesthesiol 2018; 35:621-626. [PMID: 29474346 DOI: 10.1097/eja.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Procedures requiring optimisation of the coagulation status of patients using vitamin K antagonists are frequently postponed due to the late availability of laboratory international normalised ratio (INR) test results. A point-of-care (POC) alternative may facilitate early decision-making in peri-operative patients. OBJECTIVES To assess the level of agreement between the POC-INR and the laboratory INR in patients who continue or stop vitamin K antagonists to determine whether the POC test may be a good alternative to the laboratory INR. DESIGN Study of diagnostic accuracy. SETTING Single-centre study at Zaans Medical Centre, The Netherlands. PATIENTS Included patients were scheduled for cardioversion (these continued taking vitamin K antagonists), or a surgical procedure (these stopped taking vitamin K antagonists). MAIN OUTCOME MEASURES The level of agreement and clinical acceptability of the laboratory and POC-INR results, evaluated by Bland-Altman analysis and error grid analysis. RESULTS The surgical and cardioversion groups consisted of 47 and 46 patients, respectively. The bias in the INR in the surgical group was -0.12 ± 0.09 with limits of agreement of -0.29 to 0.05, whereas the cardioversion group showed a bias in the INR of -0.22 ± 0.36 with limits of agreement from -0.93 to 0.48. The percentage errors between methods in the surgical and cardioversion groups were 16 and 21%, respectively. Error grid analysis showed that the diagnostic accuracy of the POC prothrombin time is clinically acceptable as the difference did not lead to a different clinical decision in the surgical group with INR values less than 1.8. CONCLUSION The current study shows a good level of agreement and clinical accuracy between the laboratory and POC-INR in patients who stopped anticoagulation intake for surgery. However, in patients who continued their anticoagulation therapy, the agreement between the two methods was less accurate.
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Impact of disruptions on anaesthetic workflow during anaesthesia induction and patient positioning: A prospective study. Eur J Anaesthesiol 2018; 33:581-7. [PMID: 27227550 DOI: 10.1097/eja.0000000000000484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Work disruption in operating rooms hinders flow of patients and increases chances of error. Previous studies have largely considered the types of disruption occurring in operating rooms, but have not analysed systematically the objective impact of disruption. OBJECTIVE The objective was to evaluate the impact of disruption on time efficiency in preoperative anaesthetic work in the operating room and to link disruption to failures in co-ordination of care. DESIGN Prospective, cross-sectional and observational study. SETTING Disruptions were evaluated in operating rooms of five hospitals across three countries: Australia (one community hospital, one teaching hospital); Thailand (two community hospitals); China (one teaching hospital). PARTICIPANTS The preoperative phase of anaesthesia induction/patient positioning of 64 surgical patients across specialities was prospectively evaluated (Australia = 33; Thailand = 12; China = 10). Further, interviews were carried out with 16 consultant anaesthetists and surgeons and 13 senior operating room nurses involved in the care of these patients. MAIN OUTCOME MEASURES Disruptions were identified by trained observers in real time during the preoperative phase; four types of care co-ordination problems were identified from the interviews with senior anaesthetists, surgeons and nurses, and linked to the disruptions. Descriptive analyses of time efficiency were performed. RESULTS Complete data were available from 55 cases. Good inter-observer agreement was obtained across measurements (range 74 to 92%). An average of three disruptions per case during the preoperative phase, were observed (range 2 to 9). 'Disruption types': disruptive staff activities were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 4 min 45 s per case). 'Care co-ordination problems': co-ordination lapses within the operating room team, and between them and the preoperative team were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 5 min 0 s per case). CONCLUSION The study quantifies time inefficiencies affecting anaesthetic work during the preoperative phase. Work disruption wastes time and is preventable.
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Columbus AB, Morris MA, Lilley EJ, Harlow AF, Haider AH, Salim A, Havens JM. Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery. Surgery 2018; 163:832-838. [PMID: 29331398 DOI: 10.1016/j.surg.2017.11.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/19/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. BACKGROUND Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. METHODS Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. RESULTS A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. CONCLUSION Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field.
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Affiliation(s)
- Alexandra B Columbus
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
| | - Megan A Morris
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Denver, Aurora, CO
| | - Elizabeth J Lilley
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Alyssa F Harlow
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Adil H Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Brigham and Women's Hospital, Division of Trauma, Burns and Surgical Critical Care, Boston, MA
| | - Ali Salim
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Brigham and Women's Hospital, Division of Trauma, Burns and Surgical Critical Care, Boston, MA
| | - Joaquim M Havens
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Brigham and Women's Hospital, Division of Trauma, Burns and Surgical Critical Care, Boston, MA
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Yeoh C, Tan KS, Mascarenhas J, Tollinche L. Effects of Different Communication Tools on the Efficiency of Anesthesiologists in the Perioperative Setting. ACTA ACUST UNITED AC 2017; 8. [PMID: 29399380 PMCID: PMC5793890 DOI: 10.4172/2155-6148.1000794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective To assess if Real Time Locating Systems (RTLS) technology has an effect on the perioperative efficiency of anesthesiologists at our institution. Methods A retrospective chart review was performed for all outpatient and short-stay patients who received general anesthesia and monitored anesthesia care between January and June of 2016. Patients over 18 years with an ASA classification of 1, 2, and 3 were included. Time was used as a measure of efficiency between two groups of anesthesiologists. These two comparison groups were as follows:
Group 1: Anesthesiologists at the academic center’s main campus who do not have access to RTLS Group 2: Anesthesiologists at Josie Robertson Ambulatory Surgical Center where RTLS is available and use of RTLS is compulsory
Two outcome measures were collected from patient electronic records:
DUR1: Duration between when patient is admitted to a presurgical bed and preoperative evaluation by the attending anesthesiologist DUR2: Duration between when patient is admitted to the operating room and initiation of induction by the attending anesthesiologist.
Results Anesthesiologists who had access to RTLS technology were found to be more efficient in completing their preoperative anesthesia evaluation and initiating intraoperative induction. They took less time to complete these tasks and the difference was statistically significant to p<0.0001 Conclusion Anesthesiologists at our institution, who have access to RTLS as an additional communication tool, were found to be consistently more efficient in their perioperative workflow. There are confounding factors that can account for the shorter times and more efficient perioperative workflow of anesthesiologists. With continued application and investigation over time, the utility of RTLS on workflow efficiency of healthcare providers will become more apparent.
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Affiliation(s)
- Cindy Yeoh
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kay See Tan
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jennifer Mascarenhas
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Luis Tollinche
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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Duncan DP, Wessel BE, Schacht MA, Dinglasan LAV, Mader GW, Potts MH, Samman M, Vyleta MS, Coldwell DM. Fast-Track Registration: A Way to Increase Efficiency in the IR Division. J Vasc Interv Radiol 2017; 29:125-131. [PMID: 29169784 DOI: 10.1016/j.jvir.2017.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate changes in patient registration process at an academic 2-suite IR Division to determine if moving registration from the waiting room to the vascular holding area decreased amount of time patients spent in the Radiology Department and improved start times. MATERIALS AND METHODS A data collection sheet was created by evaluating patient-related processes; event timestamps were recorded on the sheet. The control group consisted of 33 patients who registered using the traditional process. The fast-track group consisted of 29 patients who bypassed the traditional registration procedure and were registered by nurses in the vascular holding area. RESULTS Total time between control and fast-track groups significantly decreased from an average time of 215 minutes to 178 minutes (P = .020). The average start time improved significantly from an average of 63 minutes after scheduled procedure start time for the control group to 33 minutes after the scheduled procedure start time for the fast-track group (P = .009). Start time (P = .022), time spent in recovery area (P = .006), and total time, after correcting for differences in laboratory test turnaround time, (P = .010) decreased in variability after implementation of fast-track registration. CONCLUSIONS Implementing fast-track registration for outpatient subcutaneous port placement in the IR Division improved start times and decreased total time patients spent in the hospital, while also reducing variability in the process.
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Affiliation(s)
- David P Duncan
- Department of Radiology, University of Louisville Hospital, 530 South Jackson Street, CCB-C07, Louisville, KY 40202.
| | - Bryan E Wessel
- Department of Radiology, University of Louisville Hospital, 530 South Jackson Street, CCB-C07, Louisville, KY 40202
| | - Michael A Schacht
- Department of Radiology, University of Louisville Hospital, 530 South Jackson Street, CCB-C07, Louisville, KY 40202
| | - Lu Anne V Dinglasan
- Department of Radiology, University of Louisville Hospital, 530 South Jackson Street, CCB-C07, Louisville, KY 40202
| | - George W Mader
- Department of Radiology, University of Louisville Hospital, 530 South Jackson Street, CCB-C07, Louisville, KY 40202
| | - Melissa H Potts
- Department of Radiology, University of Louisville Hospital, 530 South Jackson Street, CCB-C07, Louisville, KY 40202
| | - Mahmoud Samman
- Department of Radiology, University of Louisville Hospital, 530 South Jackson Street, CCB-C07, Louisville, KY 40202
| | - Martin S Vyleta
- Department of Radiology, University of Louisville Hospital, 530 South Jackson Street, CCB-C07, Louisville, KY 40202
| | - Douglas M Coldwell
- Department of Radiology, University of Louisville Hospital, 530 South Jackson Street, CCB-C07, Louisville, KY 40202
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O'Donnell BD, Walsh K, Murphy A, McElroy B, Iohom G, Shorten GD. An evaluation of operating room throughput in a stand-alone soft-tissue trauma operating theatre. Rom J Anaesth Intensive Care 2017; 24:13-20. [PMID: 28913493 DOI: 10.21454/rjaic.7518.241.wal] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Operating room time is a limited, expensive commodity in acute hospitals. Strategies aimed at reduction of non-operative time improve operating room throughput and capacity. We conducted a prospective study to evaluate and augment operating room throughput and capacity using context-specific work practice changes. METHODS Following institutional and ethical approval, an interdisciplinary group designed and introduced a series of work practice changes specific to a stand-alone soft tissue trauma theatre, comprising modifications to patient processing, staff behaviours and additional anaesthesiologist hours. Time intervals relating to each patient were measured during a 16 week period before and after implementing work practice changes. The primary outcome measure was non-operative time, with daily caseload and cancellations amongst secondary outcome measures. RESULTS 251 procedures were included over 58 working days (8 to 17 Monday to Friday). Non-operative time [55.6 (31.1) vs 52.3 (9.8) minutes, p = 0.48], daily caseload [4 [1-9] vs 4 [2-7], p = 0.56], and the number of daily cancellations [3 [0-11] vs 5 [0-8], p = 0.38], did not differ between baseline and study phases. Regional anaesthesia for upper limb surgery increased during the study phase [26/59 (44.0%) vs 10/63 (15.9%), p = 0.014] with resultant decrease in mean duration of recovery room stay [20.7 (17.7) vs 30 (20.5) minutes, p = 0.0001] and increased recovery room bypass [26/116 (22.4%) vs 6/135 (4.4%), p = 0.0002]. Avoidable delays accounted for 124.8 (72.2) minutes of theatre time lost each day. CONCLUSION In conclusion, additional attending anaesthesiologist hours combined with work practice changes did not impact on measures of theatre throughput and capacity. The study identified important variables that contribute to avoidable delays, and points the way for future research.
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Affiliation(s)
- Brian D O'Donnell
- Department of Anaesthesia, Cork University Hospital, and University College Cork, Ireland
| | - Ken Walsh
- Department of Anaesthesia, Cork University Hospital, and University College Cork, Ireland
| | - Aileen Murphy
- Department of Economics, University College Cork, Cork, Ireland
| | - Brendan McElroy
- Department of Economics, University College Cork, Cork, Ireland
| | - Gabriella Iohom
- Department of Anaesthesia, Cork University Hospital, and University College Cork, Ireland
| | - George D Shorten
- Department of Anaesthesia, Cork University Hospital, and University College Cork, Ireland
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Shah MM, Hunter BW, Sweeney JF, Lin E, Perez SD, Parker C, Davis SS. Operating Room Efficiency in Bariatric Surgery: The Effect of Team Member Experience on Operative Times in Laparoscopic Roux-en-Y Gastric Bypass. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mihir M. Shah
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University, Atlanta, Georgia
| | - Ben W. Hunter
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University, Atlanta, Georgia
| | - John F. Sweeney
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University, Atlanta, Georgia
| | - Edward Lin
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University, Atlanta, Georgia
| | - Sebastian D. Perez
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University, Atlanta, Georgia
| | - Cheryl Parker
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University, Atlanta, Georgia
| | - Steven Scott Davis
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University, Atlanta, Georgia
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Tagge EP, Thirumoorthi AS, Lenart J, Garberoglio C, Mitchell KW. Improving operating room efficiency in academic children's hospital using Lean Six Sigma methodology. J Pediatr Surg 2017; 52:1040-1044. [PMID: 28389078 DOI: 10.1016/j.jpedsurg.2017.03.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Lean Six Sigma (LSS) is a process improvement methodology that utilizes a collaborative team effort to improve performance by systematically identifying root causes of problems. Our objective was to determine whether application of LSS could improve efficiency when applied simultaneously to all services of an academic children's hospital. METHODS In our tertiary academic medical center, a multidisciplinary committee was formed, and the entire perioperative process was mapped, using fishbone diagrams, Pareto analysis, and other process improvement tools. Results for Children's Hospital scheduled main operating room (OR) cases were analyzed, where the surgical attending followed themselves. RESULTS Six hundred twelve cases were included in the seven Children's Hospital operating rooms (OR) over a 6-month period. Turnover Time (interval between patient OR departure and arrival of the subsequent patient) decreased from a median 41min in the baseline period to 32min in the intervention period (p<0.0001). Turnaround Time (interval between surgical dressing application and subsequent surgical incision) decreased from a median 81.5min in the baseline period to 71min in the intervention period (p<0.0001). CONCLUSION These results demonstrate that a coordinated multidisciplinary process improvement redesign can significantly improve efficiency in an academic Children's Hospital without preselecting specific services, removing surgical residents, or incorporating new personnel or technology. STUDY TYPE Prospective comparative study, Level II.
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Affiliation(s)
- Edward P Tagge
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA.
| | - Arul S Thirumoorthi
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA
| | - John Lenart
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA
| | - Carlos Garberoglio
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - Kenneth W Mitchell
- Department of Process Improvement, Loma Linda University Medical Center, Loma Linda, CA
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Muhly W, McCloskey J, Feldman J, Dezayas B, Blum M, Kraus B, Mehta V, Singh D, Keren R, Flynn J. Sustained improvement in intraoperative efficiency following implementation of a dedicated surgical team for pediatric spine fusion surgery. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.pcorm.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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An analysis of surgical and nonsurgical operating room times in high-volume shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1058-1063. [PMID: 28131689 DOI: 10.1016/j.jse.2016.11.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/09/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND A significant portion of operating room time in shoulder arthroplasty is devoted to nonsurgical tasks. To maximize efficiency and to increase access to care, it is important to accurately quantify surgical and nonsurgical time for shoulder arthroplasty. This study aimed to evaluate surgical vs. nonsurgical time and to assess the viability of using a 1-surgeon, 2-operating room model. METHODS An institutional database was used to identify all primary and revision shoulder arthroplasty cases from February 2011 through December 2013. Time intervals were analyzed, including anesthesia and positioning time, surgical time, conclusion time, and turnover time. RESULTS We identified 1062 shoulder arthroplasties. The average anesthesia and positioning time was 48.2 ± 11.7 minutes, surgical time was 122.7 ± 36.4 minutes, and conclusion time was 10.5 ± 7.0 minutes. Average turnover time at our institution was 40 minutes. An average of 58.8 ± 13.8 minutes (33.2%) of the patient's time in the operating room was not surgical. A 1-room surgical model, with each case following the next, would allow 3 arthroplasties to be performed in a 10-hour surgical day. A 2-room model would allow 4 cases to be performed in a 9-hour surgical day or 5 in an 11-hour day. In this 2-room model, there would be no time in which the surgeon is absent for any surgical portion of the case. CONCLUSION For a high-volume shoulder arthroplasty practice, a 2-room model leads to greater efficiency and patient access to care without sacrificing the surgeon's presence during surgical portions of the case.
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Effect of the Implementation of a New Electronic Health Record System on Surgical Case Turnover Time. J Med Syst 2017; 41:42. [DOI: 10.1007/s10916-017-0690-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/17/2017] [Indexed: 11/25/2022]
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