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Singh D, Cai L, Watt D, Scoggins E, Wald S, Nazerali R. Improving Operating Room Efficiency Through Reducing First Start Delays in an Academic Center. J Healthc Qual 2023; 45:308-313. [PMID: 37596242 DOI: 10.1097/jhq.0000000000000398] [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: 08/20/2023]
Abstract
BACKGROUND Delays in operating room (OR) first-case start times can cause additional costs for hospitals, healthcare team frustration and delay in patient care. Here, a novel process improvement strategy to improving first-case start times is presented. METHODS First case in room start times were recorded for ORs at an academic medical center. Three interventions-automatic preoperative orders, dot phrases to permit re-creation of unavailable consent forms, and improved H&P linking to the surgical encounter-were implemented to target documentation-related delays. Monthly percentages of first-case on-time starts (FCOTS) and time saved were compared with the "preintervention" time period, and total cost savings were estimated. RESULTS During the first 3-months after implementation of the interventions, the percentage of FCOTS improved from an average of 36.7%-52.7%. Total time savings across all ORs over the same time period was found to be 55.63 hours, which is estimated to have saved a total of $121,834.52 over the 3-month interventional period. CONCLUSIONS By implementing multiple quality improvement interventions, delays to first start in room OR cases can be meaningfully reduced. Quality improvement protocols targeted toward root causes of OR delays can be a significant driver to reduce healthcare costs.
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Affiliation(s)
- Dylan Singh
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| | - Lawrence Cai
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| | - Dominique Watt
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| | - Elise Scoggins
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| | - Samuel Wald
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| | - Rahim Nazerali
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
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Mohammed F, Mohaddis M, Cheruvu MS, Morris RM, Naim Z, Khan S, Mushtaq MB, Chandran P. Influence of COVID-19 Protocols on the Efficiency of Trauma Theater: Retrospective Observational Study. Interact J Med Res 2022; 11:e35805. [PMID: 35704770 PMCID: PMC9278405 DOI: 10.2196/35805] [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: 12/17/2021] [Revised: 02/09/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has influenced health care delivery significantly. Numerous studies have highlighted that trauma theater efficiency has decreased during the COVID-19 pandemic; however, there is limited information as to exactly which stage of the patient theater journey is causing this decreased efficiency and whether efficiency can be improved. In the trauma theater of Warrington Hospital, United Kingdom, we have attempted to maintain trauma theater efficiency despite the requirement for increased infection control. OBJECTIVE The aim of this study was to evaluate the effects of additional COVID-19 infection control protocols on trauma theater efficiency in our center, considering the length of time taken for specific theater events, and to find out whether our interventions were successful in maintaining theater efficiency. METHODS We compared the efficiency of the trauma theater in a busy unit in December 2019 (pre-COVID-19) and December 2020 (with COVID-19 protocols in place). We collected time logs for different theater events for each patient in December of both years and compared the data. RESULTS There was no significant difference in the average number of cases performed per session between the COVID-19 and pre-COVID-19 time periods (P=.17). Theater start time was significantly earlier during the COVID-19 period (P<.001). There was no significant difference between the two periods in transport time, check-in time, preprocedure time, anesthetic time, and the time between cases (P>.05). A significant difference was observed in the check-out time between the two groups in the two time periods, with checking out taking longer during the COVID-19 period (P<.001). CONCLUSIONS Our results show that our theater start times were earlier during the COVID-19 pandemic, and the overall theater efficiency was maintained despite the additional COVID-19 infection control protocols that were in place. These findings suggest that well-planned infection control protocols do not need to impede trauma theater efficiency in certain settings.
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Affiliation(s)
| | | | | | | | - Zahra Naim
- Shadan Institute of Medical Sciences, Hyderabad, India
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Zaubitzer L, Affolter A, Büttner S, Ludwig S, Rotter N, Scherl C, von Wihl S, Weiß C, Lammert A. [Time management in operating rooms-a cross-sectional study to evaluate estimated and objective durations of otorhinolaryngologic surgical procedures]. HNO 2021; 70:436-444. [PMID: 34778901 PMCID: PMC9160095 DOI: 10.1007/s00106-021-01119-9] [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] [Accepted: 10/04/2021] [Indexed: 01/22/2023]
Abstract
Hintergrund Die Gestaltung des Operations(Op.)-Programms im klinischen Alltag ist von hoher Wichtigkeit für die Wirtschaftlichkeit. Gleichzeitig muss die Einhaltung von Arbeitszeiten unterschiedlicher Berufsgruppen berücksichtigt werden. Ziel der Arbeit Um Fehlerquellen bei der Planung aufzudecken, wurden durch Chirurgen geschätzte mit objektiv erhobenen Zeiten (u. a. Schnitt-Naht-Zeit) verglichen. Material und Methoden In einer retrospektiven Analyse wurden 1809 Operationen im Jahr 2018 (22 verschiedene Op.-Arten) durch 31 Operateure (12 Fach- [FÄ] und 19 Assistenzärzte [AÄ]) hinsichtlich ihrer Dauer verglichen und mittels Mann-Whitney-U-Test auf Signifikanz geprüft. Ergebnisse Der Vergleich der objektiven Zeiten von FÄ und AÄ zeigt signifikante Unterschiede in der Schnitt-Naht-Zeit bzw. der Summe aus Schnitt-Naht-Zeit und Zeit der chirurgischen Maßnahmen für 6 von 15 Op.-Arten (p < 0,001). Die durch FÄ geschätzte Nachbereitungszeit wich bei 2 von 22 Op.-Arten von der objektiven Zeit ab (p < 0,05), die durch AÄ geschätzte Zeit bei 7 von 15 Op.-Arten (p < 0,05). Hinsichtlich der Schnitt-Naht-Zeit verschätzten sich FÄ bei 7 von 22 (p < 0,05), AÄ bei 3 von 15 (p < 0,05) Op.-Arten. Die durch FÄ geschätzte Vorbereitungszeit wich bei 16 von 22 Op.-Arten signifikant von der objektiven Zeit ab (p < 0,05), bei AÄ bei 7 von 15 (p < 0,001). Vor- und Nachbereitungszeiten wurden durch FÄ unter‑, Schnitt-Naht-Zeiten überschätzt. AÄ unterschätzten alle Zeiten. Schlussfolgerung Bei der OP-Planung muss die Erfahrung des durchführenden Chirurgen berücksichtigt werden. Eine Verbesserung durch verminderte subjektive Fehleinschätzung kann möglicherweise mithilfe spezieller Algorithmen gelingen.
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Affiliation(s)
- Lena Zaubitzer
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Annette Affolter
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Sylvia Büttner
- Medizinische Statistik, Biomathematik und Informationsverarbeitung, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Sonja Ludwig
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Nicole Rotter
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Claudia Scherl
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Sonia von Wihl
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Christel Weiß
- Medizinische Statistik, Biomathematik und Informationsverarbeitung, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Anne Lammert
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Clemo R, Parsons AS, Boggan JC, Shieh L, Miller BP. Learning by Doing: Practical Strategies to Integrate Resident Education and Quality Improvement Initiatives. J Grad Med Educ 2021; 13:631-634. [PMID: 34721789 PMCID: PMC8527936 DOI: 10.4300/jgme-d-21-00381.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rebecca Clemo
- Rebecca Clemo, MD, is Chief Resident, Internal Medicine Residency Program, University of Virginia School of Medicine
| | - Andrew S. Parsons
- Andrew S. Parsons, MD, MPH, is Associate Program Director, Internal Medicine Residency Program, and Assistant Professor, Department of Medicine and Public Health Sciences, Section of Hospital Medicine, University of Virginia School of Medicine
| | - Joel C. Boggan
- Joel C. Boggan, MD, MPH, is Associate Program Director, Internal Medicine Residency Program, and Assistant Professor, Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine
| | - Lisa Shieh
- Lisa Shieh, MD, PhD, is Clinical Professor of Medicine, Associate Chief Quality Officer, Medical Director of Quality, Department of Medicine, and Medical Director of GME QI programs, Stanford University School of Medicine
| | - Bahnsen P. Miller
- Bahnsen P. Miller, MD, is Assistant Professor, Department of Medicine, Section of Hospital Medicine, University of Virginia School of Medicine
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