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Pu Z, Wu S, Han Y. A discrete-event simulation model for assessing operating room efficiency of thoracic, gastrointestinal, and orthopedic surgeries. World J Surg 2024; 48:1102-1110. [PMID: 38429988 DOI: 10.1002/wjs.12116] [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: 10/20/2023] [Accepted: 02/10/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND In hospital management, pinpointing steps that most enhance operating room (OR) throughput is challenging. While prior literature has utilized discrete event simulation (DES) to study specific strategies such as scheduling and resource allocation, our study examines an earlier planning phase, assessing all workflow stages to determine the most impactful steps for subsequent strategy development. METHODS DES models real-world systems by simulating sequential events. We constructed a DES model for thoracic, gastrointestinal, and orthopedic surgeries summarized from a tertiary Chinese hospital. The model covers preoperative preparations, OR occupation, and OR preparation. Parameters were sourced from patient data and staff experience. Model outcome is OR throughput. Post-validation, scenario analyses were conducted for each department, including: (1) improving preoperative patient preparation time; (2) increasing PACU beds; (3) improving OR preparation time; (4) use of new equipment to reduce the operative time of a selected surgery type; three levels of improvement (slight, moderate, large) were investigated. RESULTS The first three improvement scenarios resulted in a 1%-5% increase in OR throughput across the three departments. Large reductions in operative time of the selected surgery types led to approximately 12%, 33%, and 38% increases in gastrointestinal, thoracic, and orthopedic surgery throughput, respectively. Moderate reductions resulted in 6%-17% increases in throughput and slight reductions of 1%-7%. CONCLUSIONS The model could reliably reflect OR workflows of the three departments. Among the options investigated, model simulations suggest that improving OR preparation time and operative time are the most effective.
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Affiliation(s)
- Zhongchan Pu
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuqing Wu
- Nursing Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi Han
- Health Economic Research Institute, Sun Yat-sen University, Guangzhou University City, Guangzhou, China
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Lex JR, Entezari B, Toor J, Abbas A, Nousiainen M, Rahman C, Whyne C, Ravi B. Intraoperative scrub nurse turnover in orthopaedic surgery procedures: An opportunity for improved operating room efficiency. J Healthc Qual Res 2024; 39:155-162. [PMID: 38580507 DOI: 10.1016/j.jhqr.2024.03.002] [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: 09/09/2023] [Revised: 02/08/2024] [Accepted: 03/15/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Scrub nurses play a crucial role in facilitating orthopaedic surgeries, and thus intraoperative scrub nurse turnover may disrupt the workflow of the surgical team and prolong duration of surgery (DOS). The purpose of this study was to quantify the impact of intraoperative scrub nurse turnover on operative time of orthopaedic surgeries lasting less than 3h in duration. METHODS Prospectively collected databases from two institutions were retrospectively queried to identify all orthopaedic procedures of maximum mean duration of 180min from March 4th, 2018 to August 31st, 2022. Cases were divided into two groups, those with scrub nurse turnover and those without. Propensity score matching was conducted to match groups by surgeon, hospital, patient age, gender, and ASA classification. Unpaired t-tests were used to compare mean DOS for each surgical procedure. Average treatment effect on treated (ATET) with 95% confidence intervals (CIs) were calculated. RESULTS Scrub nurse turnover significantly prolonged DOS for both bone forearm facture open reduction and internal fixation (ORIF) (ATET=21.08, p=0.001), ankle ORIF (ATET=21.26, p<0.001), clavicle ORIF (ATET=16.16, p=0.028), femur intramedullary nail (ATET=11.52, p=0.003), rotator cuff repair (ATET=16.88, p<0.001), partial discectomy (ATET=10.52, p=0.001), total knee arthroplasty (TKA) (ATET=5.69, p<0.001), anterior total hip arthroplasty (THA) (ATET=8.80, p<0.001), lateral THA (ATET=7.02, p<0.001), and uncemented hip hemiarthroplasty (ATET=16.79, p=0.049). CONCLUSION Intraoperative scrub nurse turnover significantly prolongs surgical times in orthopaedic surgeries lasting up to 3h in duration. This highlights the importance of developing strategies to prevent intraoperative scrub nurse turnover to improve OR efficiency and decrease healthcare costs.
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Affiliation(s)
- J R Lex
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, Toronto, ON, Canada; Division of Orthopaedic Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - B Entezari
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada; Queen's University School of Medicine, Kingston, ON, Canada.
| | - J Toor
- Division of Orthopaedic Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - A Abbas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Nousiainen
- Division of Orthopaedic Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Rahman
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Whyne
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, Toronto, ON, Canada; Division of Orthopaedic Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - B Ravi
- Division of Orthopaedic Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Afford R, Chan M, Garelnabi R, Ali Akbari FH, Wiseman SM. Improving First Case Operating Room Efficiency. J Healthc Qual 2024:01445442-990000000-00066. [PMID: 38697092 DOI: 10.1097/jhq.0000000000000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
INTRODUCTION Improving transition to the operating room (OR) can enhance healthcare efficiency. Our aim was to determine whether adopting a communication board (CB) for first case surgical patients reduced delays to OR. METHODS A retrospective observational study was conducted from April to October 2021. We calculated differences in surgical daycare (SDC) departure time before and after implementation of the CB, differences in departure whether the CB was used or not, delay in variability between surgical specialties, and overall adoption of the CB. RESULTS After CB adoption, 13% of first cases left SDC by predefined target times. The mean delay in transfer was 18:51 minutes. When the CB was used, cases were on average 10:43 late, compared with 26:00 when it was not used. Otolaryngology had the shortest delays while plastic surgery had the longest. Reasons for delays included staffing delays, holds, and pending laboratory results. CONCLUSIONS Introducing a CB significantly reduced delays in transferring first case surgical patients from SDC to the OR.
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Athanasiadis DI, Monfared S, Timsina L, Whiteside J, Banerjee A, Butler A, Stefanidis D. Evaluation of operating room inefficiencies and their impact on operating room duration using a surgical app. Am J Surg 2024:S0002-9610(24)00239-3. [PMID: 38679510 DOI: 10.1016/j.amjsurg.2024.04.022] [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: 02/10/2024] [Revised: 03/09/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Efficient utilization of the operating room (OR) is essential. Inefficiencies are thought to cause preventable delays. Our goal was to identify OR incidents causing delays and estimate their impact on the duration of various general surgery procedures. MATERIALS Three trained observers prospectively collected intraoperative data using the ExplORer Surgical app, a tool that helped capture incidents causing delays. The impact of each incident on case duration was assessed using multivariable analysis. RESULTS 151 general surgery procedures were observed. The mean number of incidents was 2.7 per each case that averaged 109min. On average, each incident caused a 2.8 min delay (p < 0.001), however, some incidents were associated with longer delays. The procedural step of each procedure most susceptible to incidents was also defined. CONCLUSION The identification of the type of incidents and the procedural step during which they occur may allow targeted interventions to optimize OR efficiency and decrease operative time.
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Affiliation(s)
| | - Sara Monfared
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lava Timsina
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jake Whiteside
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ambar Banerjee
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Annabelle Butler
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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Kang DW, Zhou S, Niranjan S, Rogers A, Shen C. Predicting operative time for metabolic and bariatric surgery using machine learning models: a retrospective observational study. Int J Surg 2024; 110:1968-1974. [PMID: 38270635 PMCID: PMC11019972 DOI: 10.1097/js9.0000000000001107] [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: 09/11/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Predicting operative time is essential for scheduling surgery and managing the operating room. This study aimed to develop machine learning (ML) models to predict the operative time for metabolic and bariatric surgery (MBS) and to compare each model. METHODS The authors used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database between 2016 and 2020 to develop ML models, including linear regression, random forest, support vector machine, gradient-boosted tree, and XGBoost model. Patient characteristics and surgical features were included as variables in the model. The authors used the mean absolute error, root mean square error, and R 2 score to evaluate model performance. The authors identified the 10 most important variables in the best-performing model using the Shapley Additive exPlanations algorithm. RESULTS In total, 668 723 patients were included in the study. The XGBoost model outperformed the other ML models, with the lowest root mean square error and highest R 2 score. Random forest performed better than linear regression. The relative performance of the ML algorithms remained consistent across the models, regardless of the surgery type. The surgery type and surgical approach were the most important features to predict the operative time; specifically, sleeve gastrectomy (vs. Roux-en-Y gastric bypass) and the laparoscopic approach (vs. robotic-assisted approach) were associated with a shorter operative time. CONCLUSIONS The XGBoost model best predicted the operative time for MBS among the ML models examined. Our findings can be useful in managing the operating room scheduling and in developing software tools to predict the operative times of MBS in clinical settings.
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Affiliation(s)
- Dong-Won Kang
- Department of Surgery, Penn State College of Medicine
| | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Suman Niranjan
- Department of Logistics and Operations Management, G. Brint Ryan College of Business, University of North Texas, Denton, Texas, USA
| | - Ann Rogers
- Department of Surgery, Penn State College of Medicine
| | - Chan Shen
- Department of Surgery, Penn State College of Medicine
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Hedlund J, Blomberg K, Hjelmqvist H, Jaensson M. Student Nurse Anesthetists' and Supervisors' Perspectives of Learning in the Operating Room: An Integrative Review. J Perianesth Nurs 2024; 39:303-310.e8. [PMID: 37906248 DOI: 10.1016/j.jopan.2023.07.023] [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: 01/30/2023] [Revised: 06/21/2023] [Accepted: 07/27/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE The purpose of this review was to identify supporting and hindering factors for student nurse anesthetists' (SNAs') learning in the operating room during clinical practice, from students' and supervisors' perspectives. DESIGN An integrative review. METHODS Systematic searches were conducted in Medline, Cinahl, PsycInfo, and ERIC. Search terms were related to nurse anesthetist, education, operating room context, and clinical setting. Searches were performed at three points in time and in total 1,530 unique articles were identified. After screening using Covidence and using Joanna Briggs Institute appraisal tools, 34 articles remained. These were analyzed inductively using a constant comparison method. FINDINGS Supporting factors include preparation before clinical practice, clearly stated expectations, a respectful relationship with the supervisor, daily planning and communication, and constructive feedback. Hindering factors include lack of time, disruptive behavior from supervisors or other team members, and environmental factors such as a high room temperature and noisy environment. CONCLUSIONS SNAs' learning situation in the operating room resembles undergraduate nurses' learning during clinical practice. Educators and supervisors can take several actions to promote SNAs' learning. Further research is warranted on the effect of teamwork on SNAs' learning.
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Affiliation(s)
- Jakob Hedlund
- Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Hans Hjelmqvist
- Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Loukas C, Seimenis I, Prevezanou K, Schizas D. Prediction of remaining surgery duration in laparoscopic videos based on visual saliency and the transformer network. Int J Med Robot 2024; 20:e2632. [PMID: 38630888 DOI: 10.1002/rcs.2632] [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: 01/19/2024] [Revised: 03/26/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Real-time prediction of the remaining surgery duration (RSD) is important for optimal scheduling of resources in the operating room. METHODS We focus on the intraoperative prediction of RSD from laparoscopic video. An extensive evaluation of seven common deep learning models, a proposed one based on the Transformer architecture (TransLocal) and four baseline approaches, is presented. The proposed pipeline includes a CNN-LSTM for feature extraction from salient regions within short video segments and a Transformer with local attention mechanisms. RESULTS Using the Cholec80 dataset, TransLocal yielded the best performance (mean absolute error (MAE) = 7.1 min). For long and short surgeries, the MAE was 10.6 and 4.4 min, respectively. Thirty minutes before the end of surgery MAE = 6.2 min, 7.2 and 5.5 min for all long and short surgeries, respectively. CONCLUSIONS The proposed technique achieves state-of-the-art results. In the future, we aim to incorporate intraoperative indicators and pre-operative data.
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Affiliation(s)
- Constantinos Loukas
- Laboratory of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Seimenis
- Laboratory of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Prevezanou
- Laboratory of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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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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Chen X, He J, Peng L, Lin L, Cheng P, Xiao Y, Liu S. Impact of a Task-Grabbing System for surgical technicians on operating room efficiency. Sci Rep 2024; 14:4296. [PMID: 38383755 PMCID: PMC10881986 DOI: 10.1038/s41598-024-54524-9] [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: 05/29/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
The purpose of this study was to evaluate the effect of the Task-Grabbing System on operating room efficiency. Based on the competition-driven concept of the 'Uber' app, an Task-Grabbing System was designed for task allocation and quality assessment. We implemented the Task-Grabbing System in our hospital operating room and compared the differences in consecutive operation preparation time, turnover time, and task completion time performed by surgical technicians for tasks such as patient pick-up, operating room cleaning, medical equipment recovery, three-piece set delivery, as well as blood gas analysis and intraoperative specimen submission before (October 2019) and after (December 2019) the implementation of the Task-Grabbing System. After the implementation of the Task-Grabbing System, the consecutive operation preparation time was reduced from the average of 43.56-38.55 min (P < 0.05), and the turnover time was decreased from the average of 14.25-12.61 min (P < 0.05). And the respective time consuming of surgical technicians for patients picking up, operating room cleaning, medical facilities recovering, the three-piece set delivering, blood gas analysis sending and intraoperative specimen submitting was significantly shortened (P < 0.05). The Task-Grabbing System could improve the operating room efficiency and effectively mobilize the enthusiasm and initiative of the surgical technicians.
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Affiliation(s)
- Xiuwen Chen
- Teaching and Research Section of Clinical Nursing, Department of Operating Room, Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jiqun He
- Teaching and Research Section of Clinical Nursing, Department of Operating Room, Xiangya Hospital, Central South University, Changsha, China
| | - Luofang Peng
- Teaching and Research Section of Clinical Nursing, Department of Operating Room, Xiangya Hospital, Central South University, Changsha, China
| | - Li Lin
- Teaching and Research Section of Clinical Nursing, Department of Operating Room, Xiangya Hospital, Central South University, Changsha, China
| | - Pengfei Cheng
- School of Business, Hunan University of Science and Technology, Xiangtan, China
| | - Yao Xiao
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Shiqing Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Sales Coll M, De Castro R, Ochoa de Echagüen A, Martínez Ibáñez V. Economic Impact of Lean Healthcare Implementation on the Surgical Process. Healthcare (Basel) 2024; 12:512. [PMID: 38470622 PMCID: PMC10930714 DOI: 10.3390/healthcare12050512] [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: 01/14/2024] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES The objective of this study was to analyse and detail surgical process improvement activities that achieve the highest economic impact. METHODS Over 4 years, a team of technicians and healthcare professionals implemented a set of Lean surgical process improvement projects at Vall d'Hebron University Hospital (VHUH), Barcelona, Spain. Methods employed in the study are common in manufacturing environments and include reducing waiting and changeover time (SMED), reducing first time through, pull, and continuous flow. Projects based on these methods now form part of the daily routine in the surgical process. The economic impact on the hospital's surgical activity budget was analysed. RESULTS Process improvements have led to annual operational savings of over EUR 8.5 million. These improvements include better patient flow, better management of information between healthcare professionals, and improved logistic circuits. CONCLUSIONS The current cultural shift towards process management in large hospitals implies shifting towards results-based healthcare, patient-perceived value (VBHC), and value-added payment. A Lean project implementation process requires long-term stability. The reason a considerable number of projects fail to complete process improvement projects is the difficulty involved in establishing the project and improving management routines. Few studies in the literature have investigated the economic impact of implementing Lean management a posteriori, and even fewer have examined actual cases. In this real case study, changes to surgical block management were initiated from stage zero. After being carefully thought through and designed, changes were carried out and subsequently analysed.
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Affiliation(s)
| | - Rodolfo De Castro
- Department of Organization, Business Management and Product Design, University of Girona, 17003 Girona, Spain
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Matz E, Dutta R, Tsivian M, Terlecki R, Matthews C. The impact of verbal goal setting on operating room turnover time: a randomized trial. Int Urogynecol J 2024; 35:363-367. [PMID: 37962631 DOI: 10.1007/s00192-023-05680-5] [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: 07/07/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Operating room turnover times are highly variable, with longer times having a significant negative impact on hospital costs, surgeon volume, and satisfaction. The primary aim of this randomized trial was to examine the impact of a verbalized time goal on the likelihood of meeting institutional goals. METHODS This is a prospective, single-blind, randomized study conducted across four operative sites: inpatient main campus and three outpatient centers. Sequential cases for the same surgeon in the same room were randomized to receive a verbal prompt versus usual care, in which no goal setting was verbalized. Multivariate and univariate statistical analyses were performed. RESULTS From July through October 2022, five attending surgeons randomized 88 cases (44 verbal prompt, 44 usual care). Of these, 30 were at the main inpatient hospital. The case mixture included 36% vaginal, 27% endoscopy, 8% open, 10% robotic, and others. Average turnover time was 51.7 and 35.3 min for inpatient and outpatient cases respectively. Overall, only 39.8% of cases hit the institutional turnover time goal. Verbal prompting did not significantly increase the likelihood of achieving the institutional goal (38.4% vs 43.4% p = 0.352) except for in minor surgery (64.0 vs 39.0%, p = 0.0477). A verbal prompt reduced turnover time in major surgery (59.7 vs 47.8 min, p = 0.0445). CONCLUSION Our academic center achieved goal turnover times in only 39.8% of cases. Although verbal prompting did not significantly improve the likelihood of meeting institutional goals in the group as a whole, some subgroups were significantly improved.
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Affiliation(s)
- Ethan Matz
- Department of Urology, University of Texas, Southwestern, 5323 Harry Hines Blvd, MC 9110, Dallas, TX, 75390, USA.
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA.
| | - Rahul Dutta
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
- Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Matvey Tsivian
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - Ryan Terlecki
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - Catherine Matthews
- Wake Forest School of Medicine, Department of Urology, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
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Xue L, Han D. Comparison of Two Anesthetic Regimens on Extubation Time and Postoperative Recovery in Children Undergoing Ambulatory Adenoidectomy: A Retrospective Study. J Perianesth Nurs 2024; 39:66-72. [PMID: 37768264 DOI: 10.1016/j.jopan.2023.06.004] [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: 01/05/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE This aim of this study was to compare two anesthetic regimens in terms of extubation time and postoperative recovery in children undergoing ambulatory adenoidectomy. DESIGN A retrospective cohort study with propensity score matching. METHODS The medical charts of 452 children aged between 3 and 8 years undergoing ambulatory adenoidectomy were retrieved for analysis, of which 438 were eligible to participate in this study. A majority (n = 327) were children exposed to a conventional propofol-pronounced general anesthetic regimen (high-dose propofol plus low-dose remifentanil, labeled as group P), while n = 111 were administered a modified remifentanil-pronounced anesthetic regimen (low-dose propofol plus high-dose remifentanil, namely group R). Propensity score matching was employed to adjust for confounders, resulting in 69 matched patients in each group. The primary endpoint of this study was extubation time. The secondary endpoints were total intraoperative fluid volume, length of stay in the postanesthesia care unit (PACU), postoperative pain rating, the incidence of emergence agitation, nausea and vomiting, as well as the level of consciousness (fully awake or waking by gentle patting) when transferred out of PACU, and any major complications (wound bleeding, reintubation, readmission, and overnight stay). FINDINGS No major complications were observed in both groups. Compared to group P, group R had significantly shorter extubation time (8.2 ± 1.4 minutes vs 13.3 ± 2.4 minutes, P < .001), shorter length of stay in the PACU (14.1 ± 3.1 minutes vs 20.2 ± 3.4 minutes, P < .001), and a higher proportion of cases being fully awake when transferred out of the PACU (91% vs 46%, P < .001). Lastly, the pain rating, frequency of oropharyngeal airway usage, incidence of emergence agitation, and nausea and vomiting were comparable between the two groups (P > .05 for all). CONCLUSIONS Remifentanil-pronounced anesthesia was superior to propofol-pronounced anesthesia in children undergoing ambulatory adenoidectomy, given that the former was associated with a faster recovery time from anesthesia without jeopardizing patient safety.
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Affiliation(s)
- Lichao Xue
- Department of Anesthesiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Ding Han
- Department of Anesthesia, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China.
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13
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Ali JT, Yang G, Green CA, Reed BL, Madani A, Ponsky TA, Hazey J, Rothenberg SS, Schlachta CM, Oleynikov D, Szoka N. Defining digital surgery: a SAGES white paper. Surg Endosc 2024; 38:475-487. [PMID: 38180541 DOI: 10.1007/s00464-023-10551-7] [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: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas. METHODS This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology. RESULTS In its simplest form, digital surgery inserts a computer interface between surgeon and patient. We divide the digital surgery space into the following elements: advanced visualization, enhanced instrumentation, data capture, data analytics with artificial intelligence/machine learning, connectivity via telepresence, and robotic surgical platforms. We will define each area, describe specific terminology, review current advances as well as discuss limitations and opportunities for future growth. CONCLUSION Digital Surgery will continue to evolve and has great potential to bring value to all levels of the healthcare system. The surgical community has an essential role in understanding, developing, and guiding this emerging field.
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Affiliation(s)
- Jawad T Ali
- University of Texas at Austin, Austin, TX, USA
| | - Gene Yang
- University at Buffalo, Buffalo, NY, USA
| | | | | | - Amin Madani
- University of Toronto, Toronto, ON, Canada
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Todd A Ponsky
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Dmitry Oleynikov
- Monmouth Medical Center, Robert Wood Johnson Barnabas Health, Rutgers School of Medicine, Long Branch, NJ, USA
| | - Nova Szoka
- Department of Surgery, West Virginia University, Suite 7500 HSS, PO Box 9238, Morgantown, WV, 26506-9238, USA.
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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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Civitella A, Prata F, Papalia R, Citriniti V, Tuzzolo P, Pascarella G, Forastiere EMA, Ragusa A, Tedesco F, Prata SM, Anceschi U, Simone G, Muto G, Scarpa RM, Cataldo R. Laparoscopic versus Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia Management after Radical Prostatectomy: Results from a Single Center Study. J Pers Med 2023; 13:1634. [PMID: 38138861 PMCID: PMC10744694 DOI: 10.3390/jpm13121634] [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: 09/30/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Regional anesthesia, achieved through nerve blocks, has gained widespread acceptance as an effective pain management approach. This research aimed to evaluate the efficacy of laparoscopic (LAP) transversus abdominis plane (TAP) block in patients undergoing laparoscopic radical prostatectomy. (2) Methods: From January 2023 to July 2023, 60 consecutive patients undergoing minimally invasive radical prostatectomy were selected. Patients were split into two groups receiving ultrasound-guided (US) or laparoscopic-guided TAP block. The primary outcome was a pain score expressed by a 0-10 visual analog scale (VAS) during the first 72 h after surgery. (3) Results: Both LAP-TAP and US-TAP block groups were associated with lower pain scores postoperatively. No statistically significant differences were observed between the two groups in surgery time, blood loss, time to ambulation, length of stay, and pain after surgery (all p > 0.2). In the LAP-TAP block group, the overall operating room time was significantly shorter than in the US-TAP block group (140 vs. 152 min, p = 0.04). (4) Conclusions: The laparoscopic approach, compared to the US-TAP block, was equally safe and not inferior in reducing analgesic drug use postoperatively. Moreover, the intraoperative LAP-TAP block seems to be a time-sparing procedure that could be recommended when patient-controlled analgesia cannot be delivered.
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Affiliation(s)
- Angelo Civitella
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Vincenzo Citriniti
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (V.C.); (G.P.); (R.C.)
| | - Piergiorgio Tuzzolo
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Giuseppe Pascarella
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (V.C.); (G.P.); (R.C.)
| | | | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Salvatore Mario Prata
- Simple Operating Unit of Lower Urinary Tract Surgery, SS. Trinità Hospital, Sora, 03039 Frosinone, Italy;
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Giovanni Muto
- Department of Urology, GVM—Maria Pia Hospital, 10132 Turin, Italy;
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Rita Cataldo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (V.C.); (G.P.); (R.C.)
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Brigmon EP, Eastridge B. TITAN CSR: a new self-retaining retractor for abdominal surgery. Trauma Surg Acute Care Open 2023; 8:e001164. [PMID: 38020858 PMCID: PMC10649783 DOI: 10.1136/tsaco-2023-001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Self-retaining retractors provide hands-free exposure and allow surgeons to use their hands to perform surgery rather than manually retract tissues. Non-table-mounted retractors offer rapid assembly, but they have been traditionally limited in their ability to provide adequate exposure of the abdomen. Table-mounted retractors provide excellent exposure, but their cumbersome and time-intensive assembly often precludes their use in emergency settings. The TITAN CSR surgical retractor is a novel, lightweight, expandable, and modular system which offers the benefits of both designs by providing rapid assembly and effective abdominal exposure without a table attachment. We describe our experience with this new retractor system. Methods Retrospective case series of selected trauma and emergency surgery laparotomies at an urban academic level 1 trauma center using the TITAN CSR surgical retractor during a 1-year period. Results The TITAN CSR surgical retractor was used to provide exposure for trauma and emergency surgery laparotomies in both adult and pediatric patients in 89 cases from July 2021 to July 2022. Without requiring a table attachment, the TITAN CSR retractor provided hands-free surgical exposure during a variety of procedures including traumatic hysterectomy, gastrorrhaphy, enterorrhaphies and colectomy. With the added utility of attaching Bookwalter-compatible retractor blades, it provided effective exposure of retroperitoneal structures. These structures included the inferior vena cava, left femoral vessels, and duodenum. All laparotomies presented were successfully completed without setting up a post or a connection to the surgical table. Discussion The TITAN CSR surgical retractor was successfully used in a number of difficult trauma and emergency surgery laparotomies, providing effective intra-abdominal and retroperitoneal exposure without necessitating an attachment to the surgical table. This retractor has the potential to replace current retractor systems in abdominal surgery, providing the benefits of table-mounted and non-table-mounted designs while removing their various disadvantages.
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Affiliation(s)
- Erika Paola Brigmon
- Trauma and Emergency General Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Brian Eastridge
- Trauma and Emergency General Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Shen XF, Li L, Ma H, Liu J, Jin LW, Li X, Wang JS, Gao G. Influence of resilience on depression among nurses in clean operating departments: The mediating effect of life satisfaction. World J Psychiatry 2023; 13:698-706. [PMID: 37771646 PMCID: PMC10523204 DOI: 10.5498/wjp.v13.i9.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND A clean operating room is an important part of surgical and critical treatment in hospitals. The workload is substantial, the pace is rapid, and the working environment is intense; therefore, nurses who work in clean operating rooms are constantly challenged, which can lead to anxiety, depression, and other mental health issues. Life satisfaction and resilience are important factors that ensure mental health. Therefore, exploring the mediating role of life satisfaction in the influence of resilience on depression among nurses in clean operating rooms can help improve nursing services and teamwork. AIM To explore the mediating effect of satisfaction on the influence of resilience on depression among nurses in a clean operating department. METHODS From April to November 2022, 196 nurses from the Department of Clean Operating at Harbin Medical University Cancer Hospital participated in this study. Participants were selected using convenience sampling. Participants' gender, age, marital status, position, length of service, personal monthly income, daily working hours, employment status, and professional title were collected, and the Connor-Davidson resilience scale, satisfaction with life scale, and self-rating depression scale were used to evaluate resilience, life satisfaction, and depression. The researchers conducted professional training in advance, introduced the research methods to the participants before the investigation, and explained the study's significance and purpose. Surveys were distributed and collected on-site. Each questionnaire took 30 min to complete. RESULTS The average scores for life satisfaction, resilience, and depression were 3.13 (± 0.28), 4.09 (± 0.78), and 56.21 (± 8.70), respectively. The correlation between resilience and depression was negative (r = -0.829, P < 0.01). Life satisfaction was positively related to resilience (r = 0.855, P < 0.01) and negatively related to depression (r = -0.778, P < 0.01). The relationship between resilience and depression was partially mediated by life satisfaction. The value of the mediating effect was -6.853 (26.68% of the total effect). CONCLUSION Life satisfaction partially mediates the link between resilience and depression among nurses in clean operating departments.
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Affiliation(s)
- Xue-Fei Shen
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Li Li
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Hong Ma
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Jing Liu
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Li-Wei Jin
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Xue Li
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Jia-Shu Wang
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
| | - Ge Gao
- Department of Clean Operating, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
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Brown ML, Staffa SJ, Quinonez LG, DiNardo JA, Nasr VG. Predictors of anesthesia ready time: Analysis and benchmark data. JTCVS OPEN 2023; 15:446-453. [PMID: 37808038 PMCID: PMC10556934 DOI: 10.1016/j.xjon.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 10/10/2023]
Abstract
Objective Patients undergoing congenital cardiac surgery require induction of anesthesia. Our objective was to identify the median anesthesia ready time and the predictors of this time. Methods By using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we identified patients who underwent cardiopulmonary bypass procedures from 2017 to 2021. Univariate and multivariable regression modeling to predict the anesthesia ready time was performed using mixed-effects linear regression. Results After exclusion of outliers, 44,418 cases were analyzed. The median anesthesia ready time was 51 minutes (interquartile range, 38-66). On multivariable analysis, independent predictors of a longer anesthesia ready time included decreasing weight (0.3 min/10 kg, 95% CI, 0.1-0.6; P = .011), prematurity (1.5 minutes, 95% CI, 0.8-2.2; P < .001), and presence of chromosomal abnormality (3.4 minutes, 95% CI, 1.5-5.2; P < .001). An increase in the duration in anesthesia ready time was seen with increasing Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery mortality category with an additional 7.8 minutes (95% CI, 5.2-10.4; P < .001) for a Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 5 procedure compared with Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 1. Emergency versus elective case designation was associated with an anesthesia ready time reduction of 3.6 minutes (95% CI, 1.1-6.1; P = .005), and an afternoon case start was associated with an anesthesia ready time reduction of 4.2 minutes (95% CI, 2.8-5.6; P < .001). The presence of an anesthesia trainee increased the anesthesia ready time by 3.8 minutes (95% CI, 2.6-5.0; P < .001). The presence of an airway in situ decreased the anesthesia ready time by 3.6 minutes (95% CI, 1.6-5.5; P < .001), whereas an in situ arterial line decreased the anesthesia ready time by 7.4 minutes (95% CI, 4.6-10.2; P < .001). Placement of a central venous line increased the anesthesia ready time by 8.5 minutes (95% CI, 5.9-11.1; P < .001). Conclusions The median anesthesia ready time was 51 minutes. For patients with characteristics associated with prolonged anesthesia ready time, consideration should be given to allocation of additional anesthesia staffing to improve efficiency.
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Affiliation(s)
- Morgan L. Brown
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Mass
| | - Steven J. Staffa
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Mass
| | - Luis G. Quinonez
- Division of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - James A. DiNardo
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Mass
| | - Viviane G. Nasr
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Mass
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Tanna N, Clappier M, Barnett SL, Talamini MA, Coppa GF, Cifu K, Bianculli AR, Drummond D, Bello S, Smith ML. Streamlining and Consistency in Surgery: Lean Six Sigma to Improve Operating Room Efficiency. Plast Reconstr Surg 2023; 152:682-690. [PMID: 36692502 DOI: 10.1097/prs.0000000000010240] [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: 01/25/2023]
Abstract
BACKGROUND Improving perioperative efficiency helps reduce unnecessary surgical expenditure, increase operating room throughput, improve patient safety, and enhance staff and patient satisfaction. Lean Six Sigma (LSS) is a quality improvement model that has been successfully applied to eliminate inefficiencies in the business sector but has not yet been widely adopted in medicine. This study investigates the adaptation of LSS to improve operative efficiency for plastic surgery procedures. METHODS The authors followed the define, measure, analyze, improve, and control phases to implement LSS. The key outcome measures gathered were operative times, including the cut-to-close time, and the total time the patient spent in the operating room. RESULTS The study included a total of 181 patients who underwent immediate bilateral deep inferior epigastric perforator flap breast reconstruction between January of 2016 and December of 2019. The LSS interventions were associated with a decrease in total operative time from 636.36 minutes to 530.35 minutes, and a decrease in the time between incision to closure from 555.16 minutes to 458.85 minutes for a bilateral mastectomy with immediate deep inferior epigastric artery flap breast reconstruction. CONCLUSIONS This study demonstrates that LSS is useful to improve perioperative efficiency during complex plastic surgery procedures. The workflow of the procedure was improved by determining the optimal spatial positioning and distinct roles for each surgeon and preparing surgeon-specific surgical trays. Two process maps were developed to visualize the positioning of the surgeons during each stage of the procedure and depict the parallel workflow that helped improve intraoperative efficiency.
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Affiliation(s)
- Neil Tanna
- From Northwell Health
- the Donald and Barbara Zucker School of Medicine at Hofstra
| | | | | | - Mark A Talamini
- From Northwell Health
- the Donald and Barbara Zucker School of Medicine at Hofstra
| | - Gene F Coppa
- From Northwell Health
- the Donald and Barbara Zucker School of Medicine at Hofstra
| | | | | | | | | | - Mark L Smith
- From Northwell Health
- the Donald and Barbara Zucker School of Medicine at Hofstra
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20
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Tanaka MJ, Prasad R, Miller LA, Fleck MM, Stiles B, Boyne CJ, Nguyen THE. Team Approach: Improving Orthopaedic Operating Room Efficiency. JBJS Rev 2023; 11:01874474-202308000-00004. [PMID: 37549236 DOI: 10.2106/jbjs.rvw.23.00036] [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: 08/09/2023]
Abstract
The cost of surgical care accounts for almost one-third of all health care spending in the United States. Within health care spending, the operating room (OR) is one of the largest health care costs during a perioperative episode of care. Efficiency in the OR has been associated with increased productivity, safety, and quality of care. However, multiple sources of delays can contribute to inefficiency, and improving efficiency in the OR requires a systematic approach to identify and address each issue. We report on the case of a process improvement initiative implemented in a large academic institution to improve OR efficiency in outpatient orthopaedic cases, and we discuss the lessons learned through this program. Optimizing workflow in the OR requires a multidisciplinary team approach consisting of clinician leaders with common goals and open discussion regarding the needs of each team member, including circulating nurses, surgical nurses/technologists, and anesthesiologists. Our experience highlights the importance of practical, clinician-driven changes that are supported by administrative engagement, resources for staffing and equipment, and institutional flexibility, which are required to implement systemic changes to address and improve efficiency in the OR.
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Affiliation(s)
- Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rashmi Prasad
- Department of Anesthesia, Johns Hopkins University, Baltimore, Maryland
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21
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Stavrides KP, Lindemann TL, Harlor EJ, Haugen TW, Purdy N. Accurate Operative Time Prediction in Thyroid Surgery: A Rural Tertiary Care Facility Experience. EAR, NOSE & THROAT JOURNAL 2023; 102:498-503. [PMID: 33978503 DOI: 10.1177/01455613211016702] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine whether surgeons can estimate thyroid operative time more accurately than a system-generated average time estimate. METHODS Four otolaryngologists at a single institution with extensive endocrine surgery experience were asked to predict their operative times for all eligible thyroid surgeries. These estimates were compared to system-generated operative time predications based on averaging the surgeon's previous 10 cases with the same Current Procedural Terminology code. The surgeon-generated estimations and system-generated estimations were then compared to each other and the actual operative time. RESULTS A final sample of 73 cases was used for all analyses. Average age was 51 years old and the majority of patients were female. Surgeon-generated operative time estimates were significantly more accurate than system-generated estimates based on time averaging (P < .001). These findings were consistent across each surgeon individually and within each procedure type (hemithyroidectomy and total thyroidectomy). These findings had a power of over 99% based on mean differences. CONCLUSION As the financial center of modern hospitals, an efficient operating room is integral to economic success. Improving the precision of operative time estimation reduces costly unplanned staff overtime, canceled cases, and underutilization. Our research at a rural tertiary care center shows that experienced thyroid surgeons can substantially reduce the error of estimating thyroid operative times by considering individual patient characteristics. Although no objective variables have so far been identified to correlate with thyroid operative time, surgeon-generated operative time estimation is significantly more accurate than a generic system approach of averaging previous operative times.
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Affiliation(s)
- Kevin P Stavrides
- Department of Otolaryngology-Head and Neck/Facial Plastic Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Timothy L Lindemann
- Department of Otolaryngology-Head and Neck/Facial Plastic Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Evan J Harlor
- Department of Otolaryngology-Head and Neck/Facial Plastic Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Thorsen W Haugen
- Department of Otolaryngology-Head and Neck/Facial Plastic Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Nicholas Purdy
- Department of Otolaryngology-Head and Neck/Facial Plastic Surgery, Geisinger Medical Center, Danville, PA, USA
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22
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Aljaffary A, AlAnsari F, Alatassi A, AlSuhaibani M, Alomran A. Assessing the Precision of Surgery Duration Estimation: A Retrospective Study. J Multidiscip Healthc 2023; 16:1565-1576. [PMID: 37309537 PMCID: PMC10257906 DOI: 10.2147/jmdh.s403756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
Background and Objectives The operating room (OR) is considered the highest source of cost and earnings. Therefore, measuring OR efficiency, which means how time and resources are allocated precisely for their intended purposes in the operating room is crucial. Both overestimation and underestimation negatively impact OR efficiency Therefore, hospitals defined metrics to Measuring OR Effeciency. Many studies have discussed OR efficiency and how surgery scheduling accuracy plays a vital role in increasing OR efficiency. This study aims to evaluate OR efficiency using surgery duration accuracy. Methods This retrospective, quantitative study was conducted at King Abdulaziz Medical City. We extracted data on 97,397 surgeries from 2017 to 2021 from the OR database. The accuracy of surgery duration was identified by calculating the duration of each surgery in minutes by subtracting the time of leaving the OR from the time of entering the OR. Based on the scheduled duration, the calculated durations were categorized as either underestimation or overestimation. Descriptive and bivariate analyses (Chi-square test) were performed using the Statistical Package for the Social Sciences (SPSS) software. Results Sixty percent out of the 97,397 surgeries performed were overestimated compared to the time scheduled by the surgeons. Patient characteristics, surgical division, and anesthesia type showed statistically significant differences (p <0.05) in their OR estimation. Conclusion Significant proportion of procedures have overestimated. This finding provides insight into the need for improvement. Recommendations It is recommended to enhance the surgical scheduling method using machine learning (ML) models to include patient characteristics, department, anesthesia type, and even the performing surgeon increases the accuracy of duration estimation. Then, evaluate the performance of an ML model in future studies.
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Affiliation(s)
- Afnan Aljaffary
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah AlAnsari
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaleem Alatassi
- Preoperative Quality and Patient Safety Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed AlSuhaibani
- Operating Room Services Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ammar Alomran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Mirsadeghi MN, Biazar G, Soltanipour S, Rad RS, Madani ZH, Nikbin L. The effect of aminophylline on the recovery profile after hysterectomy: A randomized controlled double-blinded study. Health Sci Rep 2023; 6:e1362. [PMID: 37351459 PMCID: PMC10282175 DOI: 10.1002/hsr2.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/14/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
Background and Aims In anesthesia practice, aminophylline is clinically used to treat bronchospasm. However, due to its antagonistic effect on adenosine, studies have recently focused on the drug's ability to enhance the recovery profile. The aim of this study was to investigate the hypothesis that the administration of aminophylline leads to better recovery after general anesthesia in hysterectomy. Methods This randomized controlled double-blinded study, was conducted at Alzahra academic hospital in Guilan, Iran. During December 2022 to March 2023, 70 eligible women scheduled for elective abdominal hysterectomy were divided into two groups. Group A: received 3 mg/kg IV aminophylline diluted in 100 mL of normal saline and Group C: received 100 mL IV normal saline. The time to recovery of consciousness, tracheal extubation and discharge from post anesthesia care unit were recorded. In addition, heart rate, and mean arterial blood pressure were measured at 10 point times including; baseline (T0), immediately before the administration of aminophylline (T1), every 5 min until the end of the surgery(T2,T3,T4,T5,T6), and every 15 min in PACU(T7,T8,T9). Results There was no significant difference in terms of demographic data between the study groups. Comparing the two groups, the time of ROC was shorter in Group A than group C; 5.95 ± 1.12 and 8.5 ± 1.77 for Groups A and C, respectively (p < 0.001). The extubation time was shorter in Group A than group C; 7.79 ± 1.48 and 10.55 ± 3.02, for Groups A and C, respectively (p < 0.001). In addition, the discharge time was also shorter in group A than Group C; 30.17 ± 5.24 and 37.57 ± 4.41 for Groups A and C, respectively (p < 0.001). Not serious side effects were reported among 71.4% of cases in Group A and 51.4% in Group C (p = 0.086). Conclusion Administration of aminophylline at a dose of 3 mg/kg IV improves the recovery profile after abdominal hysterectomy without serious adverse effects.
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Affiliation(s)
- Misa Naghdipour Mirsadeghi
- Department of Gynecology, School of Medicine, Alzahra HospitalGuilan University of Medical SciencesRashtIran
| | - Gelareh Biazar
- Department of Anesthesiology, Anesthesiology Research Center, Alzahra hospitalGuilan University of Medical SciencesRashtIran
| | - Soheil Soltanipour
- Department of Community Medicine, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Reyhaneh Shahrokhi Rad
- Department of Anesthesiology, Anesthesiology Research Center, Alzahra hospitalGuilan University of Medical SciencesRashtIran
| | - Zahra Hamidi Madani
- Department of Obstetrics and Gynecology, School of Medicine, Reproductive Health Research Center, Alzahra HospitalGuilan University of Medical SciencesRashtIran
| | - Laya Nikbin
- Student Research Committee, School of MedicineGuilan University of Medical SciencesRashtIran
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Wright I. Normalization of Deviance Is Contrary to the Principles of High Reliability. AORN J 2023; 117:231-238. [PMID: 36971528 DOI: 10.1002/aorn.13894] [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: 03/25/2022] [Revised: 06/07/2022] [Accepted: 08/09/2022] [Indexed: 03/29/2023]
Abstract
Normalization of deviance is a phenomenon in which individuals and teams depart from an acceptable performance standard until the adopted way of practice becomes the new norm. This phenomenon is concerning in high-risk areas of health care because it erodes a safety culture. Additionally, it is inimical to the principles of high reliability-specifically, to the first of the five principles: preoccupation with failure. Although all high-reliability principles hold relevance to safety, preoccupation with failure describes a consistent alertness to risk and is critical for preventing adverse events, particularly in high-risk environments such as the OR. This article describes how normalization of deviance and preoccupation with failure cannot coexist and presents ways to mitigate normalization of deviance and bolster high reliability, ultimately making ORs safer for surgical patients.
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Woelfel I, Wang T, Pieper H, Meara M, Chen XP. Distortions in the Balance Between Teaching and Efficiency in the Operating Room. J Surg Res 2023; 283:110-117. [PMID: 36402083 DOI: 10.1016/j.jss.2022.10.032] [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: 02/25/2022] [Revised: 08/20/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The balance between teaching and operative efficiency (i.e., continuing operative case progression) is difficult for even the most experienced master surgeon educators. The purpose of this study was to explore influencing factors behind attending surgeons' decisions to break the balance between operative efficiency and teaching in the operating room. METHODS Semistructured interviews were conducted with surgeons across the United States via Web-based video conferencing. The interviews were audio-recorded and transcribed. Qualitative analysis using the framework method was utilized, and emergent themes were identified. RESULTS Twenty-three attending surgeons from 8 academic institutions and 11 surgical specialties completed interviews (14 men and 9 women). Attending surgeons consider a variety of factors associated with their dual roles (surgeon versus teacher) when balancing operative efficiency and providing appropriate independence for residents with oversight to promote autonomy. These were divided into surgeon-role-related factors (patient safety, financial factors, scheduling factors, preservation of faculty reputation for efficiency, and mode of operation) as well as teacher-role-related factors (preparation, level, and technical skill of the resident). These factors then informed attending surgeons' determinations about how the case was progressing, which prompted them to intervene and reduce resident autonomy or allow the resident to continue. CONCLUSIONS Surgeons consider numerous factors when deciding how to balance resident teaching and autonomy while preserving operative efficiency. These findings provide helpful insights for surgical departments to consider inclusion in faculty-development programs, resident education, and systematic improvements.
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Affiliation(s)
- Ingrid Woelfel
- Department of Surgery, Ohio State University, Columbus, Ohio.
| | - Theresa Wang
- Department of Surgery, Ohio State University, Columbus, Ohio
| | - Heidi Pieper
- Department of Surgery, Ohio State University, Columbus, Ohio
| | - Michael Meara
- Department of Surgery, Ohio State University, Columbus, Ohio
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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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Leung T, Harjai B, Simpson S, Du AL, Tully JL, George O, Waterman R. An Ensemble Learning Approach to Improving Prediction of Case Duration for Spine Surgery: Algorithm Development and Validation. JMIR Perioper Med 2023; 6:e39650. [PMID: 36701181 PMCID: PMC9912154 DOI: 10.2196/39650] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/29/2022] [Accepted: 12/25/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Estimating surgical case duration accurately is an important operating room efficiency metric. Current predictive techniques in spine surgery include less sophisticated approaches such as classical multivariable statistical models. Machine learning approaches have been used to predict outcomes such as length of stay and time returning to normal work, but have not been focused on case duration. OBJECTIVE The primary objective of this 4-year, single-academic-center, retrospective study was to use an ensemble learning approach that may improve the accuracy of scheduled case duration for spine surgery. The primary outcome measure was case duration. METHODS We compared machine learning models using surgical and patient features to our institutional method, which used historic averages and surgeon adjustments as needed. We implemented multivariable linear regression, random forest, bagging, and XGBoost (Extreme Gradient Boosting) and calculated the average R2, root-mean-square error (RMSE), explained variance, and mean absolute error (MAE) using k-fold cross-validation. We then used the SHAP (Shapley Additive Explanations) explainer model to determine feature importance. RESULTS A total of 3189 patients who underwent spine surgery were included. The institution's current method of predicting case times has a very poor coefficient of determination with actual times (R2=0.213). On k-fold cross-validation, the linear regression model had an explained variance score of 0.345, an R2 of 0.34, an RMSE of 162.84 minutes, and an MAE of 127.22 minutes. Among all models, the XGBoost regressor performed the best with an explained variance score of 0.778, an R2 of 0.770, an RMSE of 92.95 minutes, and an MAE of 44.31 minutes. Based on SHAP analysis of the XGBoost regression, body mass index, spinal fusions, surgical procedure, and number of spine levels involved were the features with the most impact on the model. CONCLUSIONS Using ensemble learning-based predictive models, specifically XGBoost regression, can improve the accuracy of the estimation of spine surgery times.
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Affiliation(s)
| | - Bhavya Harjai
- Division of Perioperative Informatics, Department of Anesthesiology, University of California, San Diego, San Diego, CA, United States
| | - Sierra Simpson
- Division of Perioperative Informatics, Department of Anesthesiology, University of California, San Diego, San Diego, CA, United States
| | - Austin Liu Du
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Jeffrey Logan Tully
- Division of Perioperative Informatics, Department of Anesthesiology, University of California, San Diego, San Diego, CA, United States
| | - Olivier George
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Ruth Waterman
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, United States
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Wongtangman K, Azimaraghi O, Freda J, Ganz-Lord F, Shamamian P, Bastien A, Mirhaji P, Himes CP, Rupp S, Green-Lorenzen S, Smith RV, Medrano EM, Anand P, Rego S, Velji S, Eikermann M. Incidence and predictors of case cancellation within 24 h in patients scheduled for elective surgical procedures. J Clin Anesth 2022; 83:110987. [PMID: 36308990 DOI: 10.1016/j.jclinane.2022.110987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Avoidable case cancellations within 24 h reduce operating room (OR) efficiency, add unnecessary costs, and may have physical and emotional consequences for patients and their families. We developed and validated a prediction tool that can be used to guide same day case cancellation reduction initiatives. DESIGN Retrospective hospital registry study. SETTING University-affiliated hospitals network (NY, USA). PATIENTS 246,612 (1/2016-6/2021) and 58,662 (7/2021-6/2022) scheduled elective procedures were included in the development and validation cohort. MEASUREMENTS Case cancellation within 24 h was defined as cancelling a surgical procedure within 24 h of the scheduled date and time. Our candidate predictors were defined a priori and included patient-, procedural-, and appointment-related factors. We created a prediction tool using backward stepwise logistic regression to predict case cancellation within 24 h. The model was subsequently recalibrated and validated in a cohort of patients who were recently scheduled for surgery. MAIN RESULTS 8.6% and 8.7% scheduled procedures were cancelled within 24 h of the intended procedure in the development and validation cohort, respectively. The final weighted score contains 29 predictors. A cutoff value of 15 score points predicted a 10.3% case cancellation rate with a negative predictive value of 0.96, and a positive predictive value of 0.21. The prediction model showed good discrimination in the development and validation cohort with an area under the receiver operating characteristic curve (AUC) of 0.79 (95% confidence interval 0.79-0. 80) and an AUC of 0.73 (95% confidence interval 0.72-0.73), respectively. CONCLUSIONS We present a validated preoperative prediction tool for case cancellation within 24 h of surgery. We utilize the instrument in our institution to identify patients with high risk of case cancellation. We describe a process for recalibration such that other institutions can also use the score to guide same day case cancellation reduction initiatives.
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Affiliation(s)
- Karuna Wongtangman
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Omid Azimaraghi
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Jeffrey Freda
- Vice President, Surgical Services, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Fran Ganz-Lord
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Peter Shamamian
- Department of Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Alexandra Bastien
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Parsa Mirhaji
- Center for Health Data Innovations, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Carina P Himes
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Samuel Rupp
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | - Richard V Smith
- Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Elilary Montilla Medrano
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Preeti Anand
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Simon Rego
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Salimah Velji
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany.
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Bailey JG, Miller A, Richardson G, Hogg T, Uppal V. Cost comparison between spinal versus general anesthesia for hip and knee arthroplasty: an incremental cost study. Can J Anaesth 2022; 69:1349-1359. [PMID: 35982355 PMCID: PMC9387885 DOI: 10.1007/s12630-022-02303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/17/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Wait list times for total joint arthroplasties have been growing, particularly in the aftermath of the COVID-19 pandemic. Increasing operating room (OR) efficiency by reducing OR time and associated costs while maintaining quality allows the greatest number of patients to receive care. METHODS We used propensity score matching to compare parallel processing with spinal anesthesia in a block room vs general anesthesia in a retrospective cohort of adult patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). We compared perioperative costs, hospital costs, OR time intervals, and complications between the groups with nonparametric tests using an intention-to-treat approach. RESULTS After matching, we included 636 patients (315 TKA; 321 THA). Median [interquartile range (IQR)] perioperative costs were CAD 7,417 [6,521-8,109], and hospital costs were CAD 10,293 [9,344-11,304]. Perioperative costs were not significantly different between groups (pseudo-median difference [MD], CAD -47 (95% confidence interval [CI], -214 to -130; P = 0.60); nor were total hospital costs (MD, CAD -78; 95% CI, -340 to 178; P = 0.57). Anesthesia-controlled time and total intraoperative time were significantly shorter for spinal anesthesia (MD, 14.6 min; 95% CI, 13.4 to 15.9; P < 0.001; MD, 15.9; 95% CI, 11.0 to 20.9; P < 0.001, respectively). There were no significant differences in complications. CONCLUSION Spinal anesthesia in the context of a dedicated block room reduced both anesthesia-controlled time and total OR time. This did not translate into a reduction in incremental cost in the spinal anesthesia group.
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Affiliation(s)
- Jonathan G Bailey
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Ashley Miller
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Glen Richardson
- Division of Orthopedic Surgery, Dalhousie University, Halifax, NS, Canada
| | - Tyler Hogg
- Case Costing, Nova Scotia Health, Halifax, NS, Canada
| | - Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Effect of Risk-Focused Diversified Safety Management Mode in Patients with Major Artery Stent Implantation. Emerg Med Int 2022; 2022:1284254. [PMID: 36212997 PMCID: PMC9546671 DOI: 10.1155/2022/1284254] [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: 08/03/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Intracranial atherosclerotic stenosis (ICAS) causes a series of neurological symptoms, such as vertigo, impaired consciousness, limb weakness, ataxia, dysphagia, ocular motility disorders, and visual impairment. With the improvement of people's living standards, there are higher requirements for nursing care. Nursing, as an indispensable part of medical care, is closely related to achieving the goal of patient's safety and the overall quality of nurses, quality of care, and nursing management methods. Objective To explore the effect of risk-centered diversified safety management in patients undergoing aortic stenting. Methods Eighty patients with cerebral infarction were selected and treated with percutaneous transluminal angioplasty and stent implantation (PTAS). Then they were divided into a control group (40 cases) with routine monitoring and an experimental group (40 cases) with risk-focused intervention of a diversified safety management model according to the mode of care. Patient satisfaction and blood index test results were compared after the intervention. Results Patients in the experimental group had 6 falls, 3 bed falls, 3 phlebitis, 4 tube slips, and 10 deep vein thrombosis, all significantly fewer than those in the control group. Thirty-eight patients in the experimental group expressed satisfaction with safe management, which was substantially better than the control group (P < 0.05). The levels of tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PA1-1), and von Willebrand factor (vWF) in the experimental group were (13.5 ± 1.3) ng/mL, (60.1 ± 9.9) ng/mL, and (2.1 ± 0.2), respectively, which were substantially lower than those in the control group ((14.6 ± 2.4) ng/mL, (64.2 ± 10.7) ng/mL, and (2.8 ± 0.3)), respectively (P < 0.05). Conclusion The risk-centered diversified safety management model can effectively reduce the probability of adverse events in patients, improve patient satisfaction with nursing services, and promote faster postoperative recovery, which has clinical application value.
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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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Dolatabad AH, Mahdiraji HA, Babgohari AZ, Garza-Reyes JA, Ai A. Analyzing the key performance indicators of circular supply chains by hybrid fuzzy cognitive mapping and Fuzzy DEMATEL: evidence from healthcare sector. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2022:1-27. [PMID: 35813308 PMCID: PMC9251035 DOI: 10.1007/s10668-022-02535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/13/2022] [Indexed: 05/04/2023]
Abstract
This study presents a multi-layer fuzzy-based decision-making approach to enhance the hospital Circular Supply Chain (CSC) performance by focusing on intensive care units (ICU) via key performance indicators analysis. In this regard, a Systematic Literature Review (SLR) and Institution Fuzzy Delphi (IFD) are employed to extract the relevant and prominent KPIs. After, a hybrid Fuzzy Cognitive Mapping (FCM) and Fuzzy Decision Making Trial and Evaluation Laboratory (FDEMATEL) have been applied to illustrate a conceptual framework for the CSC performance management of the healthcare sector in the emerging economy of Iran. As a result, eight critical indicators emanated from the SLR-IFD approach. Furthermore, sixteen relationships amongst the performance indicators were identified via hybrid FCM-FDEMATEL. Inventory availability, information availability, innovation, and technology were selected as the most influential indicators. Besides, changing the information technology category, including information availability and Innovation and technology, had the most impact on the performance of the entire CSC. This study attempts to evaluate hospitals' circular supply chain performance, by designing the circular evaluation framework. Hospital managers can use the results of this research to improve their internal circular supply chain performances in the intensive care units by understanding the different scenarios.
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Affiliation(s)
| | | | | | | | - Ahad Ai
- College of Engineering, Lawrence Technological University, Michigan, United States
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Riveros Perez E, Kerko R, Lever N, White A, Kahf S, Avella-Molano B. Operating room relay strategy for turnover time improvement: a quality improvement project. BMJ Open Qual 2022; 11:bmjoq-2022-001957. [PMID: 35902182 PMCID: PMC9341176 DOI: 10.1136/bmjoq-2022-001957] [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: 04/19/2022] [Accepted: 07/21/2022] [Indexed: 11/04/2022] Open
Abstract
IntroductionOperating room (OR) management plays a pivotal role in the healthcare system due to the high cash flow it yields. Enhancing communication in the OR, which is the common root problem for delays, might improve OR efficiency and revenues for healthcare. This study aims to evaluate the impact of an OR relay strategy on turnover time (TOT).MethodsA quality improvement project was conducted. In the intervention group, a certified registered nurse anaesthetist (CRNA) remained outside of the OR, coordinating the steps to get the next patient ready. This CRNA communicated with the anaesthesia providers within the OR via a Microsoft Team chat. The TOT for the control group was recorded from the electronic anaesthesia record system.Results/data analysisAnalysis of 636 turnovers was performed with non-parametric tests. The OR relay strategy decreased TOT for most ORs, with statistically significant results for three of the ORs and the overall ORs system. A decreased in variability between TOTs was evidenced for the overall OR and the majority of the ORs evaluated individually.ConclusionThe OR relay strategy has a positive impact on TOT.
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Jiao Y, Xue B, Lu C, Avidan MS, Kannampallil T. Continuous real-time prediction of surgical case duration using a modular artificial neural network. Br J Anaesth 2022; 128:829-837. [PMID: 35090725 PMCID: PMC9074795 DOI: 10.1016/j.bja.2021.12.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/07/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Real-time prediction of surgical duration can inform perioperative decisions and reduce surgical costs. We developed a machine learning approach that continuously incorporates preoperative and intraoperative information for forecasting surgical duration. METHODS Preoperative (e.g. procedure name) and intraoperative (e.g. medications and vital signs) variables were retrieved from anaesthetic records of surgeries performed between March 1, 2019 and October 31, 2019. A modular artificial neural network was developed and compared with a Bayesian approach and the scheduled surgical duration. Continuous ranked probability score (CRPS) was used as a measure of time error to assess model accuracy. For evaluating clinical performance, accuracy for each approach was assessed in identifying cases that ran beyond 15:00 (commonly scheduled end of shift), thus identifying opportunities to avoid overtime labour costs. RESULTS The analysis included 70 826 cases performed at eight hospitals. The modular artificial neural network had the lowest time error (CRPS: mean=13.8; standard deviation=35.4 min), which was significantly better (mean difference=6.4 min [95% confidence interval: 6.3-6.5]; P<0.001) than the Bayesian approach. The modular artificial neural network also had the highest accuracy in identifying operating theatres that would overrun 15:00 (accuracy at 1 h prior=89%) compared with the Bayesian approach (80%) and a naïve approach using the scheduled duration (78%). CONCLUSIONS A real-time neural network model using preoperative and intraoperative data had significantly better performance than a Bayesian approach or scheduled duration, offering opportunities to avoid overtime labour costs and reduce the cost of surgery by providing superior real-time information for perioperative decision support.
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Affiliation(s)
- York Jiao
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO, USA.
| | - Bing Xue
- Department of Computer Science and Engineering, Washington University in St Louis, St Louis, MO, USA
| | - Chenyang Lu
- Department of Computer Science and Engineering, Washington University in St Louis, St Louis, MO, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO, USA; Institute for Informatics, Washington University School of Medicine in St Louis, St Louis, MO, USA
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Sieber T, Luedi MM. Administrative structures: options for achieving success in perioperative medicine. Best Pract Res Clin Anaesthesiol 2022; 36:257-263. [DOI: 10.1016/j.bpa.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
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Oviedo P, Engorn B, Carvalho D, Hamrick J, Fisher B, Gollin G. The impact of routine post-anesthesia care unit extubation for pediatric surgical patients on safety and operating room efficiency. J Pediatr Surg 2022; 57:100-103. [PMID: 34688493 DOI: 10.1016/j.jpedsurg.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Maximizing operating room (OR) efficiency is essential for hospital cost containment and effective patient throughput. Little data is available regarding the safety and efficacy of extubation of children in the post-anesthesia care unit (PACU) by a nurse rather than in the OR. We sought to evaluate the impact of a long-standing practice of PACU extubation upon airway complications and OR efficiency. METHODS The records of 1930 children who underwent inguinal hernia repair, laparoscopic appendectomy or pyloromyotomy at a children's hospital between July, 2018 and June, 2020 were reviewed. Extubations were performed in the OR only when the PACU was inadequately staffed or during the early months of the Covid-19 pandemic. Cases in which there was a deep extubation, a PACU hold was in effect or a patient went directly to an inpatient unit from the OR were excluded. Intra- and post-operative time metrics were recorded and emergency airway interventions were assessed. RESULTS 1747 operations were evaluated. Time from the end of the procedure to leaving the OR ranged from 4.1 to 4.8 min when extubation was done in the PACU and was 6-9 min less than with OR extubation. (see table). There were 23 airway events (1.5% of all cases) after PACU extubation that necessitated only brief bag-mask ventilation. There were no cases of re-intubation. CONCLUSIONS In a large population of children undergoing diverse surgical procedures, post-anesthesia care unit extubation was safe and resulted in rapid transfer of patients from the operating room after completion of their operation. Time saved because of shorter operating room times reduces hospital costs and can allow for increased throughput. Extubation in the post-anesthesia care unit may not only be as safe as operating room extubation, but may result in fewer serious airway events as patients may be less likely to have their endotracheal tube removed prematurely. LEVEL OF EVIDENCE Treatment Study, Level III.
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Affiliation(s)
- Parisa Oviedo
- Department of Surgery, University of California, San Diego, CA 92037, United States.
| | - Branden Engorn
- Division of Pediatric Anesthesiology, Rady Children's Hospital, San Diego, CA, United States
| | - Daniela Carvalho
- Division of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA, United States
| | - Justin Hamrick
- Division of Pediatric Anesthesiology, Rady Children's Hospital, San Diego, CA, United States
| | - Brock Fisher
- Division of Pediatric Anesthesiology, Rady Children's Hospital, San Diego, CA, United States
| | - Gerald Gollin
- Division of Pediatric Surgery, Rady Children's Hospital, San Diego, CA, United States
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Lu VM, Brusko GD, Urakov TM. Defining the Time Benefit of Awake Versus General Anesthesia for Single-Level Lumbar Spine Surgery. World Neurosurg 2021; 158:e793-e798. [PMID: 34801751 DOI: 10.1016/j.wneu.2021.11.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Awake anesthesia with monitored anesthesia care (MAC) might confer time benefits compared with traditional general anesthesia (GA) in the setting of single-level lumbar spine surgery. Therefore, we sought to define the quantitative time difference spent in the operating room between the MAC and GA approaches for single-level lumbar spine surgery. METHODS A prospectively maintained database of the senior surgeon was reviewed for single-level lumbar spine surgeries from 2019 to 2020 performed with the patient under either GA or MAC. The patient demographics, clinical features, time in the operating room, and postoperative outcomes were all summarized and statistically compared. RESULTS A total of 53 patients satisfied all the selection criteria, with 25 (47%) in the GA group and 28 (53%) in the MAC group. Overall, most patients were men, with a median age of 60 years. The 2 groups were statistically comparable with respect to the demographics and preoperative anesthesia parameters. The time from room arrival to sedation start (median time, 26 vs. 38 minutes; P < 0.01), sedation time (median time, 55 vs. 87 minutes; P < 0.01), and time from sedation end to room exit (median time, 4 vs. 13 minutes; P < 0.01) were all significantly shorter for the MAC group. Additionally, the estimated blood loss was less in the MAC group (P < 0.01). CONCLUSIONS We found MAC to be a safe anesthesia option for use in single-level lumbar spine surgery, which led to statistically significant benefits regarding the time under sedation and time in the operating room compared with GA. Future studies are required to understand whether MAC will require other synergistic measures to generate observable change at a health systems level.
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Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Jackson Health System, Miami, Florida, USA.
| | - G Damian Brusko
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Jackson Health System, Miami, Florida, USA
| | - Timur M Urakov
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Jackson Health System, Miami, Florida, USA; Department of Neurological Surgery, Miami Veteran Affairs Healthcare System, Miami, Florida, USA
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Nyberg A, Olofsson B, Otten V, Haney M, Fagerdahl AM. Patient safety during joint replacement surgery: experiences of operating room nurses. BMJ Open Qual 2021; 10:bmjoq-2021-001604. [PMID: 34750189 PMCID: PMC8576473 DOI: 10.1136/bmjoq-2021-001604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/25/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Avoidable complications for surgical patients still occur despite efforts to improve patient safety processes in operating rooms. Analysis of experiences of operating room nurses can contribute to better understanding of perioperative processes and flow, and why avoidable complications still occur. AIM To explore aspects of patient safety practice during joint replacement surgery through assessment of operating room nurse experiences. METHOD A qualitative design using semistructured interviews with 21 operating room nurses currently involved in joint replacement surgery in Sweden. Inductive qualitative content analysis was used. RESULTS The operating room nurses described experiences with patient safety hazards on an organisational, team and individual level. Uncertainties concerning a reliable plan for the procedure and functional reporting, as well as documentation practices, were identified as important. Teamwork and collaboration were described as crucial at the team level, including being respected as valuable, having shared goals and common expectations. On the individual level, professional knowledge, skills and experience were needed to make corrective steps. CONCLUSION The conditions to support patient safety, or limit complication risk, during joint replacement surgery continue to be at times inconsistent, and require steady performance attention. Operating room nurses make adjustments to help solve problems as they arise, where there are obvious risks for patient complications. The organisational patient safety management process still seems to allow deviation from established practice standards at times, and relies on individual-based corrective measures at the 'bedside' at times for good results.
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Affiliation(s)
- Anette Nyberg
- Department of Nursing, Faculty of Medicine, Umeå University, Umeå, Sweden .,Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Department of Nursing, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Surgical and Perioperative Sciences, Orthopedics, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Volker Otten
- Department of Surgical and Perioperative Sciences, Orthopedics, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Michael Haney
- Department of Surgical and Perioperative Sciences, Anesthesiology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Armoeyan M, Aarabi A, Akbari L. The Effects of Surgery Cancellation on Patients, Families, and Staff: A Prospective Cross-Sectional Study. J Perianesth Nurs 2021; 36:695-701.e2. [PMID: 34565663 DOI: 10.1016/j.jopan.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: 11/05/2020] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to investigate the effects of surgery cancellation, as a common and never-ending problem within preoperative care, and its related factors on patients, family members, and medical staff. DESIGN The research design implemented a prospective cross-sectional type. METHODS This study was conducted for four months in two main teaching/general medical centers. The data collection tool was comprised of three researcher-made questionnaires for patients, families, and medical staff, separately. The samples also included a total number of 315 patients, family members, and medical staff. FINDINGS The results revealed that the frequency distribution of all physical and emotional effects was higher in men than in women though it was not statistically significant. Each patient had been fasting for an average of 13.26 hours until the announcement of surgery cancellation. The most prevalent physical effects in the patients were hunger, thirst, and headache, respectively. The average cost of each surgery cancellation for the patients was almost twice that for the family members. There was a significant correlation between emotional effects in the patients and the families and the reason for cancellation and informants. CONCLUSIONS Each surgery cancellation increased fasting time in patients by an average of 5 to 7 hours. Cancellation also correspondingly led to economic harms for the patients and the families, waste of operating room resources, and duplications. Since the most common reasons for surgery cancellation were patient-related and a significant correlation was observed between the reason for cancellation and emotional effects in the patients and the families, our recommendation is to strengthen patient protocols in terms of preoperative preparation and to review admission and information processes for patients undergoing surgeries.
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Affiliation(s)
- Moslem Armoeyan
- Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences. Isfahan, Iran
| | - Akram Aarabi
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences. Isfahan, Iran.
| | - Leila Akbari
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences. Isfahan, Iran
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Wong T, Zhang EJ, Elhajj AJ, Rizzo DM, Sexton KA, Pandit JJ, Tsai MH. The Power Law in Operating Room Management. J Med Syst 2021; 45:92. [PMID: 34494167 DOI: 10.1007/s10916-021-01764-1] [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: 06/21/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
The Acute Care Surgery model has been implemented by many hospitals in the United States. As complex adaptive systems, healthcare systems are composed of many interacting elements that respond to intrinsic and extrinsic inputs. Systems level analysis may reveal the underlying organizational structure of tactical block allocations like the Acute Care Surgery model. The purpose of this study is to demonstrate one method to identify a key characteristic of complex adaptive systems in the perioperative services. Start and end times for all surgeries performed at the University of Vermont Medical Center OR1 were extracted for two years prior to the transition to an Acute Care Surgery service and two years following the transition. Histograms were plotted for the inter-event times calculated from the difference between surgical cases. A power law distribution was fit to the post-transition histogram. The Kolmogorov-Smirnov test for goodness-of-fit at 95% level of significance shows the histogram plotted from post-transition inter-event times follows a power law distribution (K-S = 0.088, p = 0.068), indicating a Complex Adaptive System. Our analysis demonstrates that the strategic decision to create an Acute Care Surgery service has direct implications on tactical and operational processes in the perioperative services. Elements of complex adaptive systems can be represented by a power law distributions and similar methods may be applied to identify other processes that operate as complex adaptive systems in perioperative care. To make sustained improvements in the perioperative services, focus on manufacturing-based interventions such as Lean Six Sigma should instead be shifted towards the complex interventions that modify system-specific behaviors described by complex adaptive system principles when power law relationships are present.
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Affiliation(s)
- Timothy Wong
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, US
| | - Erik J Zhang
- University of Vermont Larner College of Medicine, Burlington, VT, US
| | - Andrea J Elhajj
- College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, US
| | - Donna M Rizzo
- Department of Civil & Environmental Engineering, University of Vermont, Burlington, VT, US
| | - Kevin A Sexton
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, US
| | | | - Mitchell H Tsai
- Department of Anesthesiology, Department of Orthopaedics and Rehabilitation (By Courtesy), Department of Surgery (By Courtesy), University of Vermont Larner College of Medicine, Burlington, VT, US.
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Fernandez N, Hannick JH, Escobar R, Serrano A. Lean: Introduction of a Quality Improvement Concept into Percutaneous Nephrolithotomy to Improve Efficiency while Maintaining Safety. Rev Urol 2021. [DOI: 10.1055/s-0041-1733843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Introduction and objective Standardization of surgical interventions reduces complications and costs and positively impacts intra and postoperative outcomes. Implementation of the lean concept, initially proposed in the auto industry, now becomes an interesting approach in the surgical setting. We want to present the results of how percutaneous nephrolithotripsy (PCNL) in a high-level center can be positively impacted by implementing the lean concept.
Methods We evaluated a total of 140 PCNL procedures. Group 1 included all cases operated prior to implementing the lean concept and group 2 was composed of those operated after implementing the lean concept. We looked for all seven sources of waste to identify and modify our practice to improve efficiency and safety. We then collected intraoperative times and compared the ones prior to those after the implementation.
Results After implementing the lean concept, with an average of six PCNL cases per day, a comparison was made to an equivalent number of cases prior to the lean implementation (group 1). The average total operative time for PCNL preintervention was 138 (confidence interval [CI]: 79 to 170) minutes and postlean intervention was 71.1 (CI: 43 to 157) minutes. Surgical time (cystoscopy to skin closure) was 36.1 (CI: 25 to 50) minutes prelean and 50 minutes postlean (CI: 23 to 154). For this last one, bilateral procedures were performed. Operative room turnover time was 27.8 (CI: 21 to 38) minutes prelean and 5.67 (CI: 3.5 to 12) minutes postlean. Induction time was 16.5 (CI: 5 to 55) minutes prelean and 5.4 (CI: 3.5 to 7.5) minutes postlean.
Conclusion Implementation of the lean concept enables optimization of the surgical procedure, allowing hospitals to reduce costs and standardization.
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Affiliation(s)
- Nicolas Fernandez
- Division of Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Jessica H. Hannick
- Division of Pediatric Urology, UH Rainbow Babies and Children's Hospital, Cleveland, OH, United States
| | - Rebeca Escobar
- Division of Urology, Centro Diagnóstico Urológico, Manizales, Colombia
| | - Adolfo Serrano
- Department of Urology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Peckham ME, Anzai Y, Shah LM, de Gennaro G, Costello JA, Hutchins TA. Shifting Spine Interventional Pain Injections From the Hospital to a Clinic Setting: Increased Efficiency and Decreased Health System Costs. J Am Coll Radiol 2021; 18:1229-1234. [PMID: 34216558 DOI: 10.1016/j.jacr.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Spine interventional pain injections have dramatically increased in volume in the past three decades. High referral volumes at our institution necessitated using both a hospital-based interventional suite and a clinic-based suite scheduled on a first-come, first-served basis. We sought to determine whether the clinic-based suite provided benefits in efficiency and health system cost in comparison with the hospital suite without compromising quality of care. METHODS To investigate differences between outpatient procedures performed in hospital-based procedure rooms (HBPRs) and clinic-based procedure rooms (CBPRs), we reviewed all consecutive outpatient spine interventional pain procedures performed by the interventional neuroradiology service over a 12-month period. We analyzed procedure complexity, fluoroscopic times, procedural times, patient wait times, and health system costs for each case, as well as any complications. RESULTS Our analysis demonstrated similar procedural complexity between sites with decreased average fluoroscopic time (112 seconds versus 163 seconds, P = .002), procedural time (17 min versus 28 min, P < .001), and wait time (20 min versus 38 min, P < .001) in the CBPR versus the HBPR. In cases without trainee involvement, procedural and wait times were decreased (P < .001, P = .008) with no difference in fluoroscopy time (P = .18). There were no complications at either site. The analysis of cost to the health system demonstrated that procedures in the HBPR cost >14 times the amount to perform than in the CBPR. DISCUSSION Performing spine interventional pain procedures in a CBPR adds value by decreasing procedural, fluoroscopic, wait times, and health system cost compared with an HBPR without compromising safety.
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Affiliation(s)
- Miriam E Peckham
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah.
| | - Yoshimi Anzai
- Associate Chief Medical Quality Officer, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Lubdha M Shah
- Director of Spine Imaging, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | | | - Justin A Costello
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Troy A Hutchins
- Chief Value Officer, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
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Chomem P, Motter AA. Analysis of physical and physiological workloads of nursing in the surgical center. Work 2021; 68:425-435. [PMID: 33492266 DOI: 10.3233/wor-203383] [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] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Operating room nursing professionals are exposed to different workload. It is necessary to recognize which situations resulting from their tasks interfere with the health of the professional. OBJECTIVES We aimed to identify the physical and physiological loads on operating room nurses and their impact on the health as well as trace ergonomic recommendations based on the literature and performed analysis. METHODS The is an exploratory, observational, descriptive research conducted in the surgical center of a university hospital between August 2017 and July 2018. Nursing staff of both genders who worked as transport professionals or room circulators were included in the study. Data collection in the OR went through stages of Ergonomic Workplace Analysis (EWA), through semi-structured interviews addressing the physical and physiological work issues and a worksheet of data collected from the observations of the practitioners' actions. RESULTS The study included 20 nursing workers of both genders with an average of 17.33±12.58 years of work experience. The most reported problematic factors were: lack of material, staff pressure, patient transporting, employment legal status with the institution, and lack of communication among the practitioners. CONCLUSIONS There was a physical effort during the activity and a high prevalence of workers with pain complaints, which justifies the investigation.
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Affiliation(s)
| | - Arlete Ana Motter
- Department of Prevention and Rehabilitation in Physiotherapy, Federal University of Paraná, Curitiba, Brazil.,Graduate Program in Collective Health, Federal University of Paraná, Curitiba, Brazil
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Wallace L, Muir M, Romano L, Wyllie T, Gyomber D, Hodgson R. Assessing operating theatre efficiency: A prospective cohort study to identify intervention targets to improve efficiency. ANZ J Surg 2021; 91:2382-2388. [PMID: 34075673 DOI: 10.1111/ans.16991] [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: 03/04/2021] [Revised: 05/05/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Operating theatre efficiency is critical to providing optimum healthcare and maintaining the financial success of a hospital. This study aims to assess theatre efficiency, with a focus on staff activities, theatre utilisation and case changeover. METHODS Theatre efficiency data were collected prospectively at a single centre in metropolitan Melbourne, Australia, over two 5-week periods. Characteristics of each case and various time points were collected, corresponding to either in-theatre staff activities or patient events. RESULTS Two hundred and ninety-nine cases were prospectively audited over a range of surgical specialties. Setting up represented 42.4% (37.28 min), operating time 40.1% (35.28 min) and finishing up time 17.5% (15.43 min). Theatres were empty (turnover time) for 17.42 min, which was 39.4% of the non-operative time between operations (44.25 min, turnaround time). Plastic surgery operations required the shortest set-up and finishing times on most of the measured metrics, with general surgery and obstetrics/gynaecology having longer times. List order made a significant difference, with efficiency improving over the list and over the day for separate am and pm lists. When a patient was not on time to theatre, efficiency in both set up and finishing up metrics was significantly worse. CONCLUSIONS A large proportion of theatre time was being spent on non-operative tasks, making staff activities potential targets for operating theatre improvement interventions. Motivation and team familiarity were identified as the major factors behind efficiently run operating theatres, supporting the use of regular operating teams and maintenance of a highly motivated workforce.
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Affiliation(s)
| | - Mathew Muir
- Division of Surgery, Northern Health, Epping, Australia
| | - Linda Romano
- Division of Surgery, Northern Health, Epping, Australia
| | - Tracey Wyllie
- Division of Surgery, Northern Health, Epping, Australia
| | | | - Russell Hodgson
- Division of Surgery, Northern Health, Epping, Australia.,Department of Surgery, University of Melbourne, Epping, Australia
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Zbeidy R, Franklin Dos Santos T, Patel R, Souki FG. Strategies for improving anesthesia ready time in the obstetric operating room. J Clin Anesth 2021; 73:110302. [PMID: 34023638 DOI: 10.1016/j.jclinane.2021.110302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/20/2022]
Affiliation(s)
- R Zbeidy
- Dept. of Anesthesiology, University of Miami, Jackson Memorial Hospital, 1611 NW 12(th) Ave, Miami 33136, FL, USA.
| | - T Franklin Dos Santos
- Dept. of Anesthesiology, University of Miami, Jackson Memorial Hospital, 1611 NW 12(th) Ave, Miami 33136, FL, USA.
| | - R Patel
- Dept. of Anesthesiology, University of Miami, Jackson Memorial Hospital, 1611 NW 12(th) Ave, Miami 33136, FL, USA.
| | - F G Souki
- Dept. of Anesthesiology, University of Miami, Jackson Memorial Hospital, 1611 NW 12(th) Ave, Miami 33136, FL, USA.
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Normalization of Deviance: Concept Analysis. ANS Adv Nurs Sci 2021; 44:171-180. [PMID: 33624985 DOI: 10.1097/ans.0000000000000356] [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
Normalization of deviance is a phenomenon demonstrated by the gradual reduction of safety standards to a new normal after a period of absence from negative outcomes, which suggests that the absence of negative outcomes tends to reinforce the behaviors associated with cutting corners, bypassing safety checklists, and ignoring alarms. While the concept was first identified within the National Aeronautics and Space Administration, it has a strong, dangerous presence within health care, holding specific peril within high-risk environments such as the operating room. The aims of this article are to (1) analyze the concept of normalization of deviance and (2) identify the role of normalization of deviance with respect to the behavior of nurses in high-risk health care environments to prevent adverse patient outcomes. The steps outlined by Walker and Avant are applied to guide the concept analysis.
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Wright MI, Polivka B, Clark P. Exploring Normalization of Deviance among Perioperative Registered Nurses in the Operating Room. West J Nurs Res 2021; 44:116-124. [PMID: 33719741 DOI: 10.1177/0193945921999677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Normalization of deviance is a phenomenon in which individuals and teams deviate from what is known to be an acceptable performance standard until the adopted way of practice becomes normalized. In health care, this phenomenon erodes the safety culture, and it can be particularly concerning in high-risk work environments, such as the operating room (OR). The purposes of this study were to: (a) Explore the concept of normalization of deviance in the OR; (b) Identify reasons for normalization of deviance; and (c) Identify factors that protect against normalization of deviance.This focused ethnographic study included a sample of 10 perioperative nurses who were interviewed. Our findings demonstrated that normalization exists in the OR. Reasons for normalization of deviance included productivity pressures, generalized complacency, complacency related to length of experience, social pressures, and negative acculturation. Factors that protect against normalization of deviance included nurse engagement and having supportive managerial relationships.
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Affiliation(s)
- M Imelda Wright
- School of Nursing, University of Louisville, Louisville, KY, United States
| | - Barbara Polivka
- School of Nursing, The University of Kansas, Kansas City, KS, United States
| | - Paul Clark
- School of Nursing, University of Louisville, Louisville, KY, United States
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Hoefsmit PC, Cerfolio RJ, de Vries R, Dahele M, Zandbergen HR. Systematic Review of Interventions to Reduce Operating Time in Lung Cancer Surgery. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2021; 15:1179554920987105. [PMID: 33795942 PMCID: PMC7970684 DOI: 10.1177/1179554920987105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/17/2020] [Indexed: 12/25/2022]
Abstract
Introduction: Operating rooms are a scarce resource but often used inefficiently. Operating room efficiency emerges as an important part of maximizing surgical capacity and productivity, minimizing delays, and optimizing lung cancer outcomes. The operative time (time between patient entering and leaving the operating room) is discrete and the one that the surgical team can most directly influence. We performed a systematic review to evaluate the literature and identify methods to improve the efficiency of the intraoperative phase of operations for lung cancer. Methods: A literature search (in PubMed, Embase, Cochrane, and Scopus) was performed from inception up to March 9, 2020, according to the methodology described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Results: We identified 3 articles relevant to the intraoperative phase of lung cancer operating room efficiency. All 3 were consistent in showing clinically relevant time reductions in the intraoperative phase or procedures relevant to this phase. The authors demonstrated that the application of various improvement methodologies resulted in a substantial reduction in operative time, which was associated with a reduction in complications, and improved staff morale. Conclusions: Our systematic review found that various improvement methodologies have the potential to significantly reduce operative time for lung cancer surgery. This increases the value of lung cancer surgery. These findings are consistent with the wider literature on improving surgical efficiency.
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Affiliation(s)
- Paulien C Hoefsmit
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, USA
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - H Reinier Zandbergen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Chua MMJ, Lewis K, Huang YA, Fingliss M, Farber A. A Successful Organized Effort to Improve Operating Room First-Case Starts in a Tertiary Academic Medical Center. Am Surg 2020; 87:259-265. [PMID: 32927973 DOI: 10.1177/0003134820951430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Operating room (OR) inefficiency drives up cost, decreases revenue, and leads to surgeon, staff, and patient dissatisfaction. Given a low mean first-case start rate in our tertiary academic medical center, we developed a process to improve first-case start rates in an effort to increase OR efficiency. METHODS A working group of the OR Executive Committee was constituted to develop and implement a multistep operational plan. This plan was predicated on a sensible staggered start framework, coordination of stakeholder responsibilities, a visual preoperative Stop/Go checklist tool, real-time measurement, and feedback. RESULTS Within 11 days of implementation, 95% of first-start OR cases were tracked to start on time. Throughout the observation period (May 2015-July 2016), the goal of a daily mean 80% on-time start rate was either met or exceeded. CONCLUSIONS Implementation of an organized collaborative effort led to dramatic improvements in first OR case on-time rates. Such improvement in OR utilization may lead to an increase in staff and patient satisfaction and cost reduction.
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Affiliation(s)
- Melissa M J Chua
- 1861 Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Keith Lewis
- 12287 Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Yi-An Huang
- 1836 Department of Perioperative Services, Boston Medical Center, Boston, MA, USA
| | - Mary Fingliss
- 1836 Department of Perioperative Services, Boston University School of Medicine, Boston, MA, USA
| | - Alik Farber
- 1836 Department of Vascular Surgery, Boston Medical Center, Boston, MA, USA
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Rantala A, Pikkarainen M, Pölkki T. Health specialists' views on the needs for developing a digital gaming solution for paediatric day surgery: A qualitative study. J Clin Nurs 2020; 29:3541-3552. [PMID: 32614105 DOI: 10.1111/jocn.15393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To describe the views on the needs of health specialists to consider when developing a digital gaming solution for children and families in a paediatric day surgery. BACKGROUND Children's day surgery treatment is often cancelled at the last minute for various reasons, for example due to the lack of information. Digital gaming solutions could help families to be better oriented to the coming treatment. Despite the increasing demands for mHealth systems, there is not enough evidence-based information from the health specialist perspective for developing a digital gaming solution. DESIGN A qualitative descriptive study was conducted. METHODS Health specialists (N = 15) including 11 nurses, one physiotherapist and four doctors from different areas from one university hospital in Finland were recruited using a snowball sampling method. Semi-structured, face-to-face interviews were conducted in March and April 2019. The data were analysed using inductive conduct analyses. The COREQ checklist was used to report the data collection, analysis and the results. RESULTS The data yielded 469 open codes, 21 sub-categories, three upper categories and one main category. The main category the digital gaming solution to support knowledge, care and guidance in children's day surgery included three upper categories: (a) support for preoperative information and guidance, (b) support for intra-operative information and care, and (c) support for postoperative information, care and guidance. CONCLUSION Digital gaming solutions could be used to help children and families to be better prepared for upcoming treatments, to support communication in different languages and to improve children's pain management after operations. RELEVANCE TO CLINICAL PRACTICE Evidence-based information is important to ensure that future digital solutions answer the real needs of the staff and patients. There is a need for families and children's views to be taken into consideration when developing digital gaming solutions in the hospital context.
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Affiliation(s)
- Arja Rantala
- Research Unit of Nursing Science and Health Management, Faculty of Medicine Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Martti Ahtisaari Institute, Oulu Business School, Oulu University, Oulu, Finland.,VTT, Technical Research Centre of Finland, Oulu, Finland
| | - Tarja Pölkki
- Department of Children and Women, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
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