Increasing Operating Room Efficiency with Shop Floor Management: an Empirical, Code-Based, Retrospective Analysis

With increasing economic pressure on health care, modern hospital management is focusing at industrial optimization techniques to improve efficiency while maintaining quality. Shop floor management, a technique of code-based, process-oriented guidance directly on site is a method of lean management intended to increase efficiency in the operating room. In the literature, there is only scant evidence that the introduction of this technique alone can increase efficiency. The aim of this retrospective study is to determine whether a single tool alone can significantly improve codes. We performed an empirical, retrospective analysis of a number of codes from 3800 operations during two periods of comparison: upon introduction of shop floor management, and one year thereafter. Data was extracted from the Hospital Information System and transferred to a database. There was no statistically significant change in the relevant codes chosen, whether specific to the operating room (turnover time, first patient in the room, waiting times for anesthesia and surgery (p = 0.637) or to planning stability (scheduled, cancelled (p = 0.505), unscheduled and total operations performed (p = 0.984)). There were absolute changes, such as a reduction in the turnover time from 17:37 min to 16:26 min, even though not statistically significant (p = 0.238). Implementation of shop floor management as a single intervention is not appropriate to achieve a significant, continuous improvement in codes. A combination with other techniques such as detailed process analyses is definitely required. This could be important additional information for units using Lean Health Care strategies.

Critical evaluation of an innovative mesh for bilateral transabdominal preperitoneal (TAPP) repair of inguinal hernias

PURPOSE

Transabdominal preperitoneal hernia mesh plasty (TAPP) offers significant benefits to patients undergoing bilateral inguinal hernia repair. We evaluated a novel pre-shaped, large-pored, titanium-coated, lightweight polypropylene mesh for bilateral placement as an alternative to two separate meshes.

METHODS

Thirty-six patients underwent elective surgical repair of bilateral inguinal hernias with the new mesh at three departments of surgery in Linz and Graz, Austria, between May 1, 2015 and June 30, 2017.

RESULTS

All operations were completed without intraoperative complications or conversion to open procedures. The mean operation time was 74 min. There were no postoperative procedure-related complications with the exception of one hematoseroma of the spermatic cord. Two symptomatic medial recurrences (2/36 patients = 5.6%, 2/72 hernia repairs = 2.8%, respectively) after supravesical and medial hernia repair with the bilateral mesh were seen at structured follow-up examinations 6 and 12 months postoperatively.

CONCLUSION

Treatment of bilateral inguinal hernias with the newly designed bilateral mesh for TAPP theoretically brings benefits in terms of resistance to forces acting on the mesh. The larger area may decrease the risk for mesh bulging and recurrence, and one large mesh might provide more stable support than two separate meshes overlapping at the midline. The results of our study do not confirm these theoretical benefits regarding a high recurrence rate (2.8%) after treatment of medial hernia defects. We recommend re-designing the mesh with only a small central slit, which would provide a broader mesh bridge with sufficient overlap for all types of inguinal and femoral hernias, including medial and supravesical defects. After the mesh has been re-designed, a new study should evaluate its real benefits before it is marketed.