1
|
Dexter F, Epstein RH, Titler SS. Larger anesthesia practitioner per operating room ratios are needed to prevent unnecessary non-operative time than to mitigate patient risk: A narrative review. J Clin Anesth 2024; 96:111498. [PMID: 38759610 DOI: 10.1016/j.jclinane.2024.111498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024]
Abstract
When choosing the anesthesia practitioner to operating room (OR) ratio for a hospital, objectives are applied to mitigate patient risk: 1) ensuring sufficient anesthesiologists to meet requirements for presence during critical intraoperative events (e.g., anesthesia induction) and 2) ensuring sufficient numbers to cover emergencies outside the ORs (e.g., emergent reintubation in the post-anesthesia care unit). At a 24-OR suite with each anesthesiologist supervising residents in 2 ORs, because critical events overlapped among ORs, ≥14 anesthesiologists were needed to be present for all critical events on >90% of days. The suitable anesthesia practitioner to OR ratio would be 1.58, where 1.58 = (24 + 14)/24. Our narrative review of 22 studies from 17 distinct hospitals shows that the practitioner to OR ratio needed to reduce non-operative time is reliably even larger. Activities to reduce non-operative times include performing preoperative evaluations, making prompt evidence-based decisions at the OR control desk, giving breaks during cases (e.g., lunch or lactation sessions), and using induction and block rooms in parallel to OR cases. The reviewed articles counted the frequency of these activities, finding them much more common than urgent patient-care events. Our review shows, also, that 1 anesthesiologist per OR, working without assistants, is often more expensive, from a societal perspective, than having a few more anesthesia practitioners (i.e., ratio > 1.00). These results are generalizable among hundreds of hospitals, based on managerial epidemiology studies. The implication of our narrative review is that existing studies have already shown, functionally, that artificial intelligence and monitoring technologies based on increasing the safety of intraoperative care have little to no potential to influence anesthesia or OR productivity. There are, in contrast, opportunities to use sensor data and decision-support to facilitate communication among anesthesiologists outside of ORs to choose optimal task sequences that reduce non-operative times, thereby increasing production and OR efficiency.
Collapse
|
2
|
Dexter F, Scheib S, Xie W, Epstein RH. Bibliometric Analysis of Contributions of Anesthesiology Journals and Anesthesiologists to Operating Room Management Science. Anesth Analg 2024; 138:1120-1128. [PMID: 38091575 DOI: 10.1213/ane.0000000000006694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Anesthesiology journals appear to have been progressively publishing a smaller percentage of operating room (OR) management studies. Similarly, non-anesthesiologists have increasingly been authors of these publications. Five hypotheses were formulated to evaluate these impressions based on 2 of the authors' curation of an online, comprehensive bibliography of OR management articles and corresponding referenced course materials. METHODS We studied all 2938 publications having Scopus' SciVal topic T.6319 (OR management) more than 28 years from 1996 through May 2023, including 8608 distinct authors. RESULTS Half (50%) of the publications were absent from PubMed, and the percentage absent has been increasing progressively (Kendall's τ = 0.71; P < .0001). Fewer than half were published in journals including anesthesiology as the sole classification (20%) or as one of the classifications (27%). The anesthesiology journals have been publishing a progressively decreasing fraction (τ = -0.61; P < .0001). Among the 11 authors each contributing at least 1% of the OR management science publications, 9 were anesthesiologists and the other 2 had anesthesiologists as coauthors on all these publications. Only 3% of authors had at least 10 OR management publications from earlier years. There were 75% of authors with no such earlier publications and 85% with 0 or 1. There was a progressive increase in the number of authors publishing OR management annually and with at most 1 such earlier publication (τ = 0.90; P < .0001). Only 20% of publications had any author with at least 10 earlier OR management publications, 48% had every author with no such earlier publications, and 60% had all authors with 0 or 1. CONCLUSIONS Although most of the authors with the greatest production of OR management science were anesthesiologists, the percentage of publications in anesthesiology journals has been decreasing progressively. Anesthesiologists cannot rely solely on anesthesiology journals to keep up with the field. For most publications, every author had few or no earlier publications on the topic. Clinicians and managers relying on OR management science will continue to need to apply more information when judging whether published results can reliably be applied to their facilities.
Collapse
Affiliation(s)
- Franklin Dexter
- From the Department of Anesthesia, University of Iowa College of Medicine, Iowa City, Iowa
| | - Sara Scheib
- University of Iowa Libraries, Iowa City, Iowa
| | - Wei Xie
- University of Iowa Libraries, Iowa City, Iowa
| | | |
Collapse
|
3
|
Dexter F, Epstein RH, Fahy BG. Association of surgeons' gender with elective surgical lists in the State of Florida is explained by differences in mean operative caseloads. PLoS One 2023; 18:e0283033. [PMID: 36920948 PMCID: PMC10016664 DOI: 10.1371/journal.pone.0283033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND A recent publication reported that at three hospitals within one academic health system, female surgeons received less surgical block time than male surgeons, suggesting potential gender-based bias in operating room scheduling. We examined this observation's generalizability. METHODS Our cross-sectional retrospective cohort study of State of Florida administrative data included all 4,176,551 ambulatory procedural encounters and inpatient elective surgical cases performed January 2017 through December 2019 by 8875 surgeons (1830 female) at all 609 non-federal hospitals and ambulatory surgery centers. There were 1,509,190 lists of cases (i.e., combinations of the same surgeon, facility, and date). Logistic regression adjusted for covariables of decile of surgeon's quarterly cases, surgeon's specialty, quarter, and facility. RESULTS Selecting randomly a male and a female surgeons' quarter, for 66% of selections, the male surgeon performed more cases (P < .0001). Without adjustment for quarterly caseloads, lists comprised one case for 44.2% of male and 54.6% of female surgeons (difference 10.4%, P < .0001). A similar result held for lists with one or two cases (difference 9.1%, P < .0001). However, incorporating quarterly operative caseloads, the direction of the observed difference between male and female surgeons was reversed both for case lists with one (-2.1%, P = .03) or one or two cases (-1.8%, P = .05). CONCLUSIONS Our results confirm the aforementioned single university health system results but show that the differences between male and female surgeons in their lists were not due to systematic bias in operating room scheduling (e.g., completing three brief elective cases in a week on three different workdays) but in their total case numbers. The finding that surgeons performing lists comprising a single case were more often female than male provides a previously unrecognized reason why operating room managers should help facilitate the workload of surgeons performing only one case on operative (anesthesia) workdays.
Collapse
Affiliation(s)
- Franklin Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa, United States of America
| | - Richard H. Epstein
- Department of Anesthesiology, Perioperative Medicine & Pain Management, Miller School of Medicine, University of Miami, Miami, Florida
- * E-mail:
| | - Brenda G. Fahy
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| |
Collapse
|
4
|
Epstein RH, Dexter F, Fahy BG, Diez C. Most surgeons' daily elective lists in Florida comprise only 1 or 2 elective cases, making percent utilization unreliable for planning individual surgeons' block time. J Clin Anesth 2021; 75:110432. [PMID: 34280684 DOI: 10.1016/j.jclinane.2021.110432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE Operating room (OR) utilization has been shown in multiple studies to be an inappropriate metric for planning OR time for individual surgeons. Among surgeons with low daily caseloads, percentage utilization cannot be measured accurately because confidence limits are extremely wide. In Iowa, a largely rural state, most surgeons performed only 1 or 2 elective cases on their OR days. To assess generalizability, we analyzed Florida, a state with many high-population density areas. DESIGN Observational cohort study. SETTING The 602 facilities in Florida that performed inpatient or outpatient elective surgery from January 2010 through December 2019. SUBJECTS The providers licensed to perform surgery in Florida (physician, oral surgeons, dentists, and podiatrists) were identified by their national provider number. Hospitals were deidentified before analysis. MEASUREMENTS The primary endpoint was the mean among facilities in percentages of surgeon-day combinations ("lists") containing 1 or 2 cases. Proportions were calculated using Freeman-Tukey transformation and the harmonic mean of the number of lists at each facility. Comparison to "most" (>50%) used Student's two-sided one-group t-test. MAIN RESULTS Averaging among hospitals, most surgeons' lists included 1 or 2 cases (64.4%; 99% confidence interval [CI] 61.3%-67.4%) P < 0.00001). Many lists had 1 case (44.2%, 99% CI 41.2%-47.2%). Nearly all (96.7%) surgeons operated at just one hospital on their OR days. CONCLUSIONS Most surgeons' lists of elective surgical cases comprised 1 or 2 cases in the largely urban state of Florida, as previously found in the largely rural state of Iowa. Results were insensitive to organizational size or county population. Thus, our finding is generalizable in the United States. Consequently, neither adjusted nor raw utilization should be used solely when allocating OR time to individual surgeons. Anesthesia and nursing coverage of cases can be based on maximizing the efficiency of use of OR time.
Collapse
Affiliation(s)
- Richard H Epstein
- Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, 1400 NW 12th Avenue, Suite 4022, Miami, Florida 33136, United States of America.
| | - Franklin Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242, United States of America.
| | - Brenda G Fahy
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32608, United States of America.
| | - Christian Diez
- Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, 1611 NW 12(th) Avenue, Central Building, Suite C300, Miami, Florida 33136, United States of America.
| |
Collapse
|
5
|
Ahn PH, Dexter F, Fahy BG, Van Swol LM. Demonstrability of analytics solutions and shared knowledge of statistics and operating room management improves expected performance of small teams in correctly solving problems and making good decisions. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.pcorm.2020.100090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
6
|
Fernández-Sánchez H, King K, Enríquez-Hernández C. Revisiones Sistemáticas Exploratorias como metodología para la síntesis del conocimiento científico. ENFERMERÍA UNIVERSITARIA 2020. [DOI: 10.22201/eneo.23958421e.2020.1.697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introducción: En la actualidad los sistemas de salud alrededor del mundo apuestan por una toma decisiones clínicas basadas en la evidencia científica. Para ello, es necesario que los profesionales de la salud consulten los resultados de las investigaciones científicas. Sin embargo, dada la gran cantidad de literatura, los investigadores han desarrollado metodologías de revisión para compilar los estudios científicos dentro de un área específica. Aun cuando existen más de 10 tipos de metodologías para la revisión de la literatura, la Revisión Sistemática Exploratoria (RSE) ha recibido poca atención en la literatura sobre métodos de investigación científica de habla hispana.
Objetivo: Detallar la metodología de la RSE, sus propósitos y las fases para su desarrollo.
Desarrollo: Este trabajo detalla las generalidades de la RSE basándose en la metodología propuesta por Arksey & O’Malley. Así mismo, se describen las áreas o ámbitos donde este tipo de revisión se puede emplear, las fases para desarrollar la revisión y ejemplos de las RSE.
Conclusiones: Las RSE tienen la fortaleza de hacer saber a los profesionales de la salud sobre un tema en específico que permita incidir en las políticas públicas. Al igual que las Revisiones Sistemáticas, las RSE utilizan una metodología clara y replicable, aportando datos confiables y científicos para los profesionales de la salud.
Collapse
|
7
|
Tardiness of starts of surgical cases is not substantively greater when the preceding surgeon in an operating room is of a different versus the same specialty. J Clin Anesth 2019; 53:20-26. [DOI: 10.1016/j.jclinane.2018.09.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/29/2018] [Accepted: 09/26/2018] [Indexed: 12/15/2022]
|
8
|
At most hospitals in the state of Iowa, most surgeons' daily lists of elective cases include only 1 or 2 cases: Individual surgeons' percentage operating room utilization is a consistently unreliable metric. J Clin Anesth 2017; 42:88-92. [DOI: 10.1016/j.jclinane.2017.08.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/31/2017] [Accepted: 08/10/2017] [Indexed: 11/23/2022]
|
9
|
With directed study before a 4-day operating room management course, trust in the content did not change progressively during the classroom time. J Clin Anesth 2017; 42:57-62. [DOI: 10.1016/j.jclinane.2017.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/30/2017] [Accepted: 08/02/2017] [Indexed: 01/07/2023]
|
10
|
García-Aroca MÁ, Pandiella-Dominique A, Navarro-Suay R, Alonso-Arroyo A, Granda-Orive JI, Anguita-Rodríguez F, López-García A. Analysis of Production, Impact, and Scientific Collaboration on Difficult Airway Through the Web of Science and Scopus (1981-2013). Anesth Analg 2017; 124:1886-1896. [PMID: 28452821 DOI: 10.1213/ane.0000000000002058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bibliometrics, the statistical analysis of written publications, is an increasingly popular approach to the assessment of scientific activity. Bibliometrics allows researchers to assess the impact of a field, or research area, and has been used to make decisions regarding research funding. Through bibliometric analysis, we hypothesized that a bibliometric analysis of difficult airway research would demonstrate a growth in authors and articles over time. METHODS Using the Web of Science (WoS) and Scopus databases, we conducted a search of published manuscripts on the difficult airway from January 1981 to December 2013. After removal of duplicates, we identified 2412 articles. We then analyzed the articles as a group to assess indicators of productivity, collaboration, and impact over this time period. RESULTS We found an increase in productivity over the study period, with 37 manuscripts published between 1981 and 1990, and 1268 between 2001 and 2010 (P < .001). The difficult airway papers growth rate was bigger than that of anesthesiology research in general, with CAGR (cumulative average growth rate) since 1999 for difficult airway >9% for both WoS and Scopus, and CAGR for anesthesiology as a whole =0.64% in WoS, and =3.30% in Scopus. Furthermore, we found a positive correlation between the number of papers published per author and the number of coauthored manuscripts (P < .001). We also found an increase in the number of coauthored manuscripts, in international cooperation between institutions, and in the number of citations for each manuscript. For any author, we also identified a positive relationship between the number of citations per manuscript and the number of papers published (P < .001). CONCLUSIONS We found a greater increase over time in the number of difficult airway manuscripts than for anesthesiology research overall. We found that collaboration between authors increases their impact, and that an increase in collaboration increases citation rates. Publishing in English and in certain journals, and collaborating with certain authors and institutions, increases the visibility of manuscripts published on this subject.
Collapse
Affiliation(s)
- Miguel Ángel García-Aroca
- From the *Central University Hospital of Defence "Gómez Ulla," Madrid, Spain; †Alcalá de Henares University, Madrid, Spain; ‡Research Institute on Higher Education and Science (INAECU), Madrid, Spain; §Joint Institute for Biomedical Research of Defence (IMIDEF), Madrid, Spain; ‖Department of History of Science and Documentation, University of Valencia, Spain; ¶University Hospital "12 de Octubre," Madrid, Spain; #Complutense University, Madrid, Spain; **National Distance Education University (UNED), Madrid, Spain; and ††University Hospital "Madrid Montepríncipe," Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
11
|
Hanauer DA, Wu DTY, Yang L, Mei Q, Murkowski-Steffy KB, Vydiswaran VGV, Zheng K. Development and empirical user-centered evaluation of semantically-based query recommendation for an electronic health record search engine. J Biomed Inform 2017; 67:1-10. [PMID: 28131722 DOI: 10.1016/j.jbi.2017.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/21/2016] [Accepted: 01/23/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The utility of biomedical information retrieval environments can be severely limited when users lack expertise in constructing effective search queries. To address this issue, we developed a computer-based query recommendation algorithm that suggests semantically interchangeable terms based on an initial user-entered query. In this study, we assessed the value of this approach, which has broad applicability in biomedical information retrieval, by demonstrating its application as part of a search engine that facilitates retrieval of information from electronic health records (EHRs). MATERIALS AND METHODS The query recommendation algorithm utilizes MetaMap to identify medical concepts from search queries and indexed EHR documents. Synonym variants from UMLS are used to expand the concepts along with a synonym set curated from historical EHR search logs. The empirical study involved 33 clinicians and staff who evaluated the system through a set of simulated EHR search tasks. User acceptance was assessed using the widely used technology acceptance model. RESULTS The search engine's performance was rated consistently higher with the query recommendation feature turned on vs. off. The relevance of computer-recommended search terms was also rated high, and in most cases the participants had not thought of these terms on their own. The questions on perceived usefulness and perceived ease of use received overwhelmingly positive responses. A vast majority of the participants wanted the query recommendation feature to be available to assist in their day-to-day EHR search tasks. DISCUSSION AND CONCLUSION Challenges persist for users to construct effective search queries when retrieving information from biomedical documents including those from EHRs. This study demonstrates that semantically-based query recommendation is a viable solution to addressing this challenge.
Collapse
Affiliation(s)
- David A Hanauer
- Department of Pediatrics, University of Michigan Medical School, 5312 CC, SPC 5940, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; School of Information, University of Michigan, 105 South State Street, Ann Arbor, MI 48109, USA.
| | - Danny T Y Wu
- School of Information, University of Michigan, 105 South State Street, Ann Arbor, MI 48109, USA; Department of Pediatrics, University of Michigan Medical School, 5312 CC, SPC 5940, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Lei Yang
- School of Information, University of Michigan, 105 South State Street, Ann Arbor, MI 48109, USA.
| | - Qiaozhu Mei
- School of Information, University of Michigan, 105 South State Street, Ann Arbor, MI 48109, USA; Department of Electrical Engineering and Computer Science, University of Michigan, 2260 Hayward Street, Ann Arbor, MI 48109, USA.
| | - Katherine B Murkowski-Steffy
- Department of Health Management and Policy, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - V G Vinod Vydiswaran
- Department of Learning Health Sciences, University of Michigan Medical School, 1111 East Catherine Street, Ann Arbor, MI 48109, USA; School of Information, University of Michigan, 105 South State Street, Ann Arbor, MI 48109, USA.
| | - Kai Zheng
- Department of Health Management and Policy, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; School of Information, University of Michigan, 105 South State Street, Ann Arbor, MI 48109, USA.
| |
Collapse
|
12
|
Kovac M. Clinical Issues—November 2016. AORN J 2016; 104:459-464. [DOI: 10.1016/j.aorn.2016.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/16/2016] [Indexed: 11/28/2022]
|
13
|
Dexter F, Van Swol LM. Influence of Data and Formulas on Trust in Information from Journal Articles in an Operating Room Management Course. ACTA ACUST UNITED AC 2016; 6:329-34. [DOI: 10.1213/xaa.0000000000000298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
14
|
Luedi MM, Kauf P, Mulks L, Wieferich K, Schiffer R, Doll D. Implications of Patient Age and ASA Physical Status for Operating Room Management Decisions. Anesth Analg 2016; 122:1169-77. [DOI: 10.1213/ane.0000000000001187] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
15
|
Decreasing the Hours That Anesthesiologists and Nurse Anesthetists Work Late by Making Decisions to Reduce the Hours of Over-Utilized Operating Room Time. Anesth Analg 2016; 122:831-842. [DOI: 10.1213/ane.0000000000001136] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
16
|
Shi P, Dexter F, Epstein RH. Comparing Policies for Case Scheduling Within 1 Day of Surgery by Markov Chain Models. Anesth Analg 2016; 122:526-38. [DOI: 10.1213/ane.0000000000001074] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
17
|
Dexter F, Epstein RH. Associated Roles of Perioperative Medical Directors and Anesthesia. Anesth Analg 2015; 121:1469-78. [DOI: 10.1213/ane.0000000000001011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
18
|
Prahl A, Dexter F, Swol LV, Braun MT, Epstein RH. E-mail as the Appropriate Method of Communication for the Decision-Maker When Soliciting Advice for an Intellective Decision Task. Anesth Analg 2015; 121:669-677. [DOI: 10.1213/ane.0000000000000658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
19
|
Epstein RH, Dexter F. Management Implications for the Perioperative Surgical Home Related to Inpatient Case Cancellations and Add-On Case Scheduling on the Day of Surgery. Anesth Analg 2015; 121:206-218. [DOI: 10.1213/ane.0000000000000789] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
20
|
Luthra S, Ramady O, Monge M, Fitzsimons MG, Kaleta TR, Sundt TM. "Knife to skin" time is a poor marker of operating room utilization and efficiency in cardiac surgery. J Card Surg 2015; 30:477-87. [PMID: 25868385 DOI: 10.1111/jocs.12528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Markers of operation room (OR) efficiency in cardiac surgery are focused on "knife to skin" and "start time tardiness." These do not evaluate the middle and later parts of the cardiac surgical pathway. The purpose of this analysis was to evaluate knife to skin time as an efficiency marker in cardiac surgery. METHODS We looked at knife to skin time, procedure time, and transfer times in the cardiac operational pathway for their correlation with predefined indices of operational efficiency (Index of Operation Efficiency - InOE, Surgical Index of Operational Efficiency - sInOE). A regression analysis was performed to test the goodness of fit of the regression curves estimated for InOE relative to the times on the operational pathway. RESULTS The mean knife to skin time was 90.6 ± 13 minutes (23% of total OR time). The mean procedure time was 282 ± 123 minutes (71% of total OR time). Utilization efficiencies were highest for aortic valve replacement and coronary artery bypass grafting and least for complex aortic procedures. There were no significant procedure-specific or team-specific differences for standard procedures. Procedure times correlated the strongest with InOE (r = -0.98, p < 0.01). Compared to procedure times, knife to skin is not as strong an indicator of efficiency. A statistically significant linear dependence on InOE was observed with "procedure times" only. CONCLUSIONS Procedure times are a better marker of OR efficiency than knife to skin in cardiac cases. Strategies to increase OR utilization and efficiency should address procedure times in addition to knife to skin times.
Collapse
Affiliation(s)
- Suvitesh Luthra
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Omar Ramady
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary Monge
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael G Fitzsimons
- Division of Cardiac Anesthesia, Massachusetts General Hospital, Boston, Massachusetts
| | - Terry R Kaleta
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
21
|
Squara P, Imhoff M, Cecconi M. Metrology in medicine: from measurements to decision, with specific reference to anesthesia and intensive care. Anesth Analg 2015; 120:66-75. [PMID: 25625255 PMCID: PMC4272233 DOI: 10.1213/ane.0000000000000477] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Metrology is the science of measurements. Although of critical importance in medicine and especially in critical care, frequent confusion in terms and definitions impact either interphysician communications or understanding of manufacturers’ and engineers’ instructions and limitations when using devices. In this review, we first list the terms defined by the International Bureau of Weights and Measures regarding quantities and units, measurements, devices for measurement, properties of measuring devices, and measurement standards. The traditional tools for assessing the most important measurement quality criteria are also reviewed with clinical examples for diagnosis, alarm, and titration purposes, as well as for assessing the uncertainty of reference methods.
Collapse
Affiliation(s)
- Pierre Squara
- From the *ICU Department, Réanimation CERIC, Clinique Ambroise Paré, Neuilly, France; †Abteilung für Medizinische Informatik, Biometrie und Epidemiologie, Ruhr-Universität Bochum, Bochum, Germany; and ‡Adult Critical Care Directorate and Anaesthesia, St. George's Hospital and St. George's University of London, London, United Kingdom
| | | | | |
Collapse
|
22
|
Dexter F. High-quality operating room management research. J Clin Anesth 2014; 26:341-2. [DOI: 10.1016/j.jclinane.2014.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 11/15/2022]
|
23
|
Dexter F, Wachtel RE. Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home. Anesth Analg 2014; 118:1062-71. [DOI: 10.1213/ane.0000000000000173] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
24
|
Dexter F, Maxbauer T, Stout C, Archbold L, Epstein RH. Relative Influence on Total Cancelled Operating Room Time from Patients Who Are Inpatients or Outpatients Preoperatively. Anesth Analg 2014; 118:1072-80. [DOI: 10.1213/ane.0000000000000118] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|