1
|
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; 39:2200-2204. [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] [MESH Headings] [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.
Collapse
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
| |
Collapse
|
2
|
Cadwell JB, Weisberger JS, Gary CS, Patel S, Maisner RS, Ignatiuk A. Discrepancies in Work Relative Value Unit Assignment Based on Operative Time in Hand Surgery. Hand (N Y) 2024; 19:493-498. [PMID: 36214296 PMCID: PMC11067846 DOI: 10.1177/15589447221127335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Work relative value units (wRVUs) are an intricate component of physician reimbursement determination in the United States. This paper assesses whether wRVUs appropriately consider operative time in hand surgery. METHODS The 50 most common single Current Procedural Terminology code hand surgery cases were queried from the 2013 to 2018 National Surgical Quality Improvement Program database. The average assigned wRVUs and median operative times were calculated for each CPT. Linear regressions were calculated between operative time, wRVUs, and wRVUs per hour. Cases deviating the most from the expected wRVUs based on operative time were identified. RESULTS In all, 46 800 cases comprising the top 50 most common hand surgery procedures were identified. Among these cases, the median (range) assigned operative time was 62 minutes (18-110), wRVUs were 7.5 (3.5-18.0), and wRVUs per hour was 8.3 (4.9-14.2). There was a positive linear correlation between operative time and wRVUs (R2 = 0.60). Each additional operative hour was associated with an additional 6.3 wRVUs (P < .001). Based on this relationship, the assigned wRVUs for included cases ranged from 59.7% to 172.6% of expected. There was a weak negative relationship between wRVUs per hour and operative time (R2 = 0.25). Cases shorter than 1 hour had more wRVUs per hour than those longer than 1 hour (10.0 vs. 8.1, P = .003). However, this relationship disappeared when considering case turnover. CONCLUSION This study suggests a moderately strong positive correlation between wRVUs and operative time in hand surgery. Yet, numerous outliers from this trend exist, suggesting some discrepancies in reimbursement.
Collapse
Affiliation(s)
| | | | - Cyril S. Gary
- MedStar Georgetown University Hospital, Washington, DC, USA
| | | | | | | |
Collapse
|
3
|
Kurkowski SC, Gerak SK, Thimmesch MJ, Kuechly HA, Nissen KS, Valenti AC, Patel RD, Grawe BM. Effects of Surgeon-Preferred Staff and Staff Turnover on Operating Time and Complication Rates in Reverse and Anatomic Total Shoulder Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00014. [PMID: 38754005 PMCID: PMC11101225 DOI: 10.5435/jaaosglobal-d-24-00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND This study focuses on investigating the risk factors of increased operating room time and patient complication rates after total shoulder arthroplasty cases (both reverse and anatomic). We hypothesize that the use of surgeon-preferred staff will improve operating room efficiency and reduce complication rates while increased staff turnover will decrease efficiency and increase complications. METHODS This is a single-center, retrospective study focused on determining the effects of staffing on operating room time and efficiency in total shoulder arthroplasty. The study included patients who underwent total shoulder arthroplasty by a single fellowship-trained orthopaedic surgeon from 2018 to 2023. RESULTS Four hundred twenty-three patients were included in the study from August 2018 to April 2023, 264 of which were reverse total shoulder arthroplasty (rTSA) and 159 were anatomic total shoulder arthroplasty (aTSA). In both rTSA and aTSA, the presence of surgeon-preferred staff markedly decreased operating room time. In rTSA, staff turnover increased risk of 90-day complications. CONCLUSION Because the presence of surgeon-preferred staff affects operating room time and efficiency, orthopaedic surgeons should train multiple surgical teams so that efficiency is not affected by the loss of personnel during a case. To reduce 90-day complication rates in rTSA, staff breaks and turnover should be minimized as much as possible because this has a direct effect on patient outcomes. Effort from hospital administration and management should be put toward reducing turnover to improve patient outcomes.
Collapse
Affiliation(s)
- Sarah C. Kurkowski
- From the Department of Orthopaedic Surgery, University of Cincinnati, Clifton Ave, OH (Dr. Kurkowski, Mr. Kuechly, and Dr. Grawe), University of Cincinnati College of Medicine, Clifton Ave, OH (Mr. Gerak, Ms. Nissen, Mr. Valenti, and Mr. Patel); and the Medical College of Wisconsin School of Medicine, Milwaukee, WI (Mr. Thimmesch)
| | - Samuel K. Gerak
- From the Department of Orthopaedic Surgery, University of Cincinnati, Clifton Ave, OH (Dr. Kurkowski, Mr. Kuechly, and Dr. Grawe), University of Cincinnati College of Medicine, Clifton Ave, OH (Mr. Gerak, Ms. Nissen, Mr. Valenti, and Mr. Patel); and the Medical College of Wisconsin School of Medicine, Milwaukee, WI (Mr. Thimmesch)
| | - Michael J. Thimmesch
- From the Department of Orthopaedic Surgery, University of Cincinnati, Clifton Ave, OH (Dr. Kurkowski, Mr. Kuechly, and Dr. Grawe), University of Cincinnati College of Medicine, Clifton Ave, OH (Mr. Gerak, Ms. Nissen, Mr. Valenti, and Mr. Patel); and the Medical College of Wisconsin School of Medicine, Milwaukee, WI (Mr. Thimmesch)
| | - Henry A. Kuechly
- From the Department of Orthopaedic Surgery, University of Cincinnati, Clifton Ave, OH (Dr. Kurkowski, Mr. Kuechly, and Dr. Grawe), University of Cincinnati College of Medicine, Clifton Ave, OH (Mr. Gerak, Ms. Nissen, Mr. Valenti, and Mr. Patel); and the Medical College of Wisconsin School of Medicine, Milwaukee, WI (Mr. Thimmesch)
| | - K. Schuyler Nissen
- From the Department of Orthopaedic Surgery, University of Cincinnati, Clifton Ave, OH (Dr. Kurkowski, Mr. Kuechly, and Dr. Grawe), University of Cincinnati College of Medicine, Clifton Ave, OH (Mr. Gerak, Ms. Nissen, Mr. Valenti, and Mr. Patel); and the Medical College of Wisconsin School of Medicine, Milwaukee, WI (Mr. Thimmesch)
| | - Adam C. Valenti
- From the Department of Orthopaedic Surgery, University of Cincinnati, Clifton Ave, OH (Dr. Kurkowski, Mr. Kuechly, and Dr. Grawe), University of Cincinnati College of Medicine, Clifton Ave, OH (Mr. Gerak, Ms. Nissen, Mr. Valenti, and Mr. Patel); and the Medical College of Wisconsin School of Medicine, Milwaukee, WI (Mr. Thimmesch)
| | - Rahul D. Patel
- From the Department of Orthopaedic Surgery, University of Cincinnati, Clifton Ave, OH (Dr. Kurkowski, Mr. Kuechly, and Dr. Grawe), University of Cincinnati College of Medicine, Clifton Ave, OH (Mr. Gerak, Ms. Nissen, Mr. Valenti, and Mr. Patel); and the Medical College of Wisconsin School of Medicine, Milwaukee, WI (Mr. Thimmesch)
| | - Brian M. Grawe
- From the Department of Orthopaedic Surgery, University of Cincinnati, Clifton Ave, OH (Dr. Kurkowski, Mr. Kuechly, and Dr. Grawe), University of Cincinnati College of Medicine, Clifton Ave, OH (Mr. Gerak, Ms. Nissen, Mr. Valenti, and Mr. Patel); and the Medical College of Wisconsin School of Medicine, Milwaukee, WI (Mr. Thimmesch)
| |
Collapse
|
4
|
Ryan D, Rocks M, Noh K, Hacquebord H, Hacquebord J. Specific Factors Affecting Operating Room Efficiency: An Analysis of Case Time Estimates. J Hand Surg Am 2024; 49:492.e1-492.e9. [PMID: 36336571 DOI: 10.1016/j.jhsa.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/31/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Operating room (OR) efficiency has an impact on surgeon productivity and patient experience. Accuracy of case duration estimation is important to optimize OR efficiency. The purpose of this study was to identify factors associated with inaccurate case time estimates in outpatient hand surgery. A better understanding of these findings may help to improve OR efficiency and scheduling. METHODS All outpatient hand surgical cases from 2018 to 2019 were reviewed. Poorly-estimated cases (i.e., poor scheduling accuracy) were defined as those cases where the actual operative time differed from the predicted time by >50% (either quicker by >50% or slower by >50% than the predicted time). The percentages of poorly-estimated cases were analyzed, categorized, and compared by surgeon, procedure type, and scheduled case length. RESULTS A total of 6,620 cases were identified. Of 1,107 (16.7%) cases with poorly estimated case durations, 75.2% were underestimated. There was no difference in the likelihood of poor estimation related to start time. Well-estimated cases tended to have longer scheduled case duration, but shorter realized case duration and surgical time. Our systems analysis identified specific surgeons and procedures as predictable outliers. Cases scheduled for 15-30 minutes frequently were inaccurate, whereas cases scheduled for 30-45 and 106-120 minutes had accurate estimates. CONCLUSIONS The accuracy of case time estimations in a standard outpatient hand surgery practice is highly variable. Nearly one-fifth of outpatient hand surgery case durations are poorly estimated, and inaccurate case time estimation can be predicted based on surgeon, procedure type, and case time. CLINICAL RELEVANCE Maximizing OR efficiency should be a priority for surgeons and hospital systems. With multiple surgeries done per day, the efficiency of the OR has an impact on surgeon productivity and patient experience.
Collapse
Affiliation(s)
- Devon Ryan
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, White Plains, NY
| | - Madeline Rocks
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, White Plains, NY
| | - Karen Noh
- Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Jacques Hacquebord
- Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, White Plains, NY; Department of Plastic Surgery, NYU Langone Health Hansjorg Wyssy, White Plains, NY.
| |
Collapse
|
5
|
Umali MIN, Castillo TR. Efficiency of Operating Room Processes for Elective Cataract Surgeries Done by Residents in a National University Hospital. Clin Ophthalmol 2020; 14:3527-3533. [PMID: 33149546 PMCID: PMC7604921 DOI: 10.2147/opth.s277550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Operating room processes must be efficient to boost profitability and minimize cost while retaining surgical care quality. This study aims to assess operating room efficiency for resident-performed elective phacoemulsification surgeries done under local anesthesia by measuring different key performance indicators and comparing this with international benchmark data. Patients and Methods This is a prospective cross-sectional study done in the Department of Ophthalmology of the Philippine General Hospital, the National University Hospital. The operating room milestones were noted and recorded by a single third-party observer in randomly selected operating rooms from April to June 2019. Results Fifty-six phacoemulsification cases in randomly selected rooms fulfilling both inclusion and exclusion criteria were observed. None of the cases started on or before the scheduled 6:30 a.m. cutting time, with an average of 34 (SD 8.53) minutes late. Entry lag was above the median, while exit lag and turnover time were above the 95th percentile compared to benchmarking data. Segment analysis also showed an increased entry lag (35.11% vs 21.5%), significantly higher than benchmarks (t: 10.99, df: 55, p<0.01). Comparison with proposed targets in other studies also showed an increased time for entry lag. Conclusion This study determined that entry lag is the performance indicator that should be addressed to improve efficiency. A multidisciplinary approach and group goal-setting are needed to implement changes in the operating room.
Collapse
Affiliation(s)
- Maria Isabel N Umali
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| | - Teresita R Castillo
- Department of Ophthalmology and Visual Sciences, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| |
Collapse
|
6
|
Milone MT, Hacquebord H, Catalano LW, Glickel SZ, Hacquebord JH. Preparatory Time-Related Hand Surgery Operating Room Inefficiency: A Systems Analysis. Hand (N Y) 2020; 15:659-665. [PMID: 30808238 PMCID: PMC7543209 DOI: 10.1177/1558944719831333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: No study exists on preparatory time-from patient's entrance into the operating room to skin incision-and its role in hand surgery operating room inefficiency. The purpose of this study was to investigate the length and variability of preparatory time and assess the relationship between several variables and preparatory time. Methods: Consecutive upper extremity cases performed for a period of 1 month by hand surgeons were reviewed at 3 surgical sites. Preparatory time was compared across locations. Cases at one location were further analyzed to assess the relationship between preparatory time and several variables. Both traditional statistical methods and Shewhart control charts, a quality control tool, were used for data analysis. Results: A total of 288 cases were performed. The mean preparatory times at the 3 sites were 25.1, 25.7, and 20.7 minutes, respectivley. Aggregated preparatory time averaged 24.4 (range 7-61) minutes, was 75% the length of the surgical time, and accounted for 34% of total operating room time. Control charts confirmed substantial variability at all locations, signifying a poorly defined process. At a single site, where 189 cases were performed by 14 different surgeons, there was no difference in preparatory time by case type, American Society of Anesthesiologists status, or case start time. Preparatory time varied by surgeon and anesthesia type. Conclusions: Preparatory time was found to be a source of inefficiency, independent of the surgical site. Control charts reinforced large variations, signifying a poorly designed process. Surgeon seemingly plays an important, albeit likely indirect, role. Efforts to improve operating room workflow should include preparatory time.
Collapse
Affiliation(s)
- Michael T. Milone
- New York University Langone Orthopedic Hospital, New York City, USA,Michael T. Milone, New York University Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY 10003, USA.
| | | | | | | | - Jacques H. Hacquebord
- New York University Langone Orthopedic Hospital, New York City, USA,New York University Langone Medical Center, New York City, USA
| |
Collapse
|
7
|
Zepeda-Lugo C, Tlapa D, Baez-Lopez Y, Limon-Romero J, Ontiveros S, Perez-Sanchez A, Tortorella G. Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155609. [PMID: 32759705 PMCID: PMC7432925 DOI: 10.3390/ijerph17155609] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.
Collapse
Affiliation(s)
- Carlos Zepeda-Lugo
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
| | - Diego Tlapa
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
- Correspondence: (D.T.); (Y.B.-L.); Tel.: +52-6461750744 (D.T.)
| | - Yolanda Baez-Lopez
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
- Correspondence: (D.T.); (Y.B.-L.); Tel.: +52-6461750744 (D.T.)
| | - Jorge Limon-Romero
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
| | - Sinue Ontiveros
- Facultad de Ciencias de la Ingeniería, Administrativas y Sociales, Universidad Autónoma de Baja California, Tecate 21460, Mexico;
| | - Armando Perez-Sanchez
- Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Tijuana 22260, Mexico;
| | - Guilherme Tortorella
- Department of Systems and Production Engineering, Universidade Federal de Santa Catarina, Florianópolis 88040, Brazil;
| |
Collapse
|
8
|
Sivasundaram L, Wang JH, Kim CY, Trivedi NN, Liu RW, Voos JE, Bafus BT, Malone KJ. Emergency Department Utilization After Outpatient Hand Surgery. J Am Acad Orthop Surg 2020; 28:639-649. [PMID: 32732657 DOI: 10.5435/jaaos-d-19-00527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify the utilization rate and most common reasons for presentation to the emergency department (ED) after elective outpatient hand surgery and to determine preoperative risk factors for these ED visits. METHODS Patients who underwent elective hand surgery at an ambulatory surgery center between 2014 and 2015 were retrospectively evaluated using the New York and Florida State Databases. The primary outcome was all-cause 7- and 30-day ED utilization rates. Reasons for presentation to the ED were recorded and manually stratified. Bivariate and multivariate analyses were performed to identify independent predictors of ED utilization. RESULTS From 2014 to 2015, 212,506 procedures were identified; the 7- and 30-day ED visit rates were 1.8% and 4.4%, respectively. Postoperative pain was the most common cause of an ED visit after outpatient hand surgery at 7 days (25.4%) and 30 days (16.1%) postoperatively. Overall, 98% of patients presenting to the ED for postoperative pain were subsequently discharged home. After controlling for confounding, comorbid congestive heart failure, chronic lung disease, diabetes, renal failure, schizophrenia, and depression were independent risk factors for an ED visit at up to 30 days postoperatively. Those with Medicare insurance were 94% more likely to present to the ED within 30 days than those with private health insurance, whereas those with Medicaid were more than three times as likely to present to the ED as those with private insurance. DISCUSSION ED utilization after outpatient hand surgery is low, with postoperative pain being the most common cause of an ED visit at all time points. Nearly 98% of patients presenting to the ED for postoperative pain are subsequently discharged home. LEVEL OF EVIDENCE Level III, Retrospective Cohort.
Collapse
Affiliation(s)
- Lakshmanan Sivasundaram
- From the Department of Orthopaedics, the University Hospitals Cleveland, Case Western Reserve University, Cleveland, OH (Dr. Sivasundaram, Dr. Wang, Dr. Kim, Dr. Trivedi, Dr. Liu, Dr. Voos, and Dr. Malone), the Department of Orthopaedics, the University Hospitals Cleveland, Sports Medicine Institute, Cleveland, OH (Dr. Voos), and the Department of Orthopaedics, the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus)
| | | | | | | | | | | | | | | |
Collapse
|
9
|
What delays your case start? Exploring operating room inefficiencies. Surg Endosc 2020; 35:2709-2714. [PMID: 32556760 DOI: 10.1007/s00464-020-07701-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Improving operating room (OR) inefficiencies benefits the OR team, hospital, and patients alike but the available literature is limited. Our goal was, using a novel surgical application, to identify any OR incidents that cause delays from the time the patient enters the OR till procedure start (preparatory phase). MATERIALS AND METHODS We conducted an IRB approved, prospective, observational study between July 2018 and January 2019. Using a novel surgical application (ExplORer Surgical) three observers recorded disrupting incidents and their duration during the preparatory phase of a variety of general surgery cases. Specifically, the number and duration of anesthesia delays, unnecessary/distracting conversations, missing items, and other delays were recorded from the moment they started until they stopped affecting the normal workflow. RESULTS Ninety-six OR cases were assessed. 20 incidents occurred in 18 (19%) of those cases. The average preparatory duration for all the cases was 20.7 ± 8.6 min. Cases without incidents lasted 19.5 ± 7.4 min while cases with incidents lasted 25.9 ± 11.2 min, p = 0.03. The average incident lasted 3.7 min, approximately 18% of the preparatory phase duration. CONCLUSION The use of the ExplORer Surgical app allowed us to accurately record the incidents happening during the preparatory phase of various general surgery operations. Such incidents significantly prolonged the preparatory duration. The identification of those inefficiencies is the first step to targeted interventions that may eventually optimize the efficiency of preoperative preparation.
Collapse
|
10
|
Discovering the barriers to efficient robotic operating room turnover time: perceptions vs. reality. J Robot Surg 2020; 14:717-724. [PMID: 31933120 DOI: 10.1007/s11701-020-01045-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
Turnover time (TOT) has remained the subject of numerous research articles and operating room (OR) committee discussions. Inefficiencies associated with TOT are multiplied when complex technology, such as surgical robots, is involved. Using a human factors approach, this study investigated impediments to efficient robotic TOT and team members' perceptions surrounding this topic. Researchers observed 20 robotic turnovers over 2 months at a tertiary hospital. TOT, cleaning time, number of staff present, bed set-up time, instrument set-up time and any major delays were recorded. Additionally, 79 OR team members completed a questionnaire regarding perceptions of OR turnover. Average TOT was 72 min (s, 24 min). Overall, cleaning required the most time (average of 27.4 min, 37.96% of TOT), followed by instrument set-up (15.4 min, 21.34% of TOT) and RN retrieval of the patient from pre-op (12 min, 17.72% of TOT). OR team members estimated that turnovers require 60.36 min. Physicians believed the greatest contributor to TOT was "time to set up the OR", while OR staff rated "instrument availability" as the greatest issue, both of which were inaccurate. OR team members' perceptions of robotic TOT and contributing factors were different from reality based on observed contributors. Data demonstrated several areas of opportunity for process improvement. These data can be used to guide the implementation of targeted interventions to improve TOT efficiency.
Collapse
|
11
|
Hartline J, Nolan V, Kelly DM, Sheffer BW, Spence DD, Pereiras L, Warner WC, Sawyer JR. Operating Room Personnel Determine Efficiency of Pediatric Spinal Fusions for Scoliosis. Spine Deform 2019; 7:702-708. [PMID: 31495469 DOI: 10.1016/j.jspd.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 12/09/2022]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES To investigate the effect of different surgeons, anesthesiologists, and cRNAs individually and in teams on various perioperative and operative time intervals in a large, high-volume children's hospital. SUMMARY OF BACKGROUND DATA Along with individual factors, studies have indicated that team factors play a role in efficiency, with larger teams leading to increased procedure times. An operating room (OR) staff dedicated to orthopedics has been reported to decrease turnover time; however, the characteristics and behaviors of surgical team members, to our knowledge, have not been analyzed as possible factors contributing to pediatric OR efficiency, and limited research has been conducted in the field of orthopedic personnel. METHODS Chart review identified consecutive pediatric and adolescent patients who had primary posterior spinal fusion (PSF) of ≥7 levels for correction of spinal deformity. Time intervals and delays were recorded based on previous studies looking at OR efficiency and adjusted to the specific time points available in our perioperative nursing records. RESULTS Adjusted for etiology, osteotomy, fusion levels, distance from hospital, staff switch, and body mass index, there was a significant difference in patient wait time among anesthesiologists, surgeon-anesthesiologist, and anesthesiologist-certified registered nurse anesthetist (cRNA) teams; in surgery prep time and total prep among surgeons and SA teams; and in surgery time and total room time among surgeons. There were no significant differences among cRNAs, individually, in any time interval. CONCLUSIONS Anesthesiologists have a significant effect before and surgeons have a significant effect after entry into the OR. Identification of this variability provides an opportunity to study the differences in habits and processes of high- and low-efficiency teams, which can then be applied to all teams with the goal of improving performance of all surgical teams. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Jacob Hartline
- College of Medicine, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA
| | - Vikki Nolan
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis, 3720 Alumni Ave, Memphis, TN 38152, USA
| | - Derek M Kelly
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Le Bonheur Children's Hospital, 1211 Union Ave. Suite 520, Memphis, TN 38104, USA
| | - Benjamin W Sheffer
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Le Bonheur Children's Hospital, 1211 Union Ave. Suite 520, Memphis, TN 38104, USA
| | - David D Spence
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Le Bonheur Children's Hospital, 1211 Union Ave. Suite 520, Memphis, TN 38104, USA
| | - Lilia Pereiras
- Department of Anesthesiology, Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN 38103, USA
| | - William C Warner
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Le Bonheur Children's Hospital, 1211 Union Ave. Suite 520, Memphis, TN 38104, USA
| | - Jeffrey R Sawyer
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Le Bonheur Children's Hospital, 1211 Union Ave. Suite 520, Memphis, TN 38104, USA.
| |
Collapse
|
12
|
Saxena RC, Whipple ME, Neradilek MB, Solomon S, Fong CT, Nair BG, Lang JD. Does Attending Surgeon Presence at the Preinduction Briefing Improve Operating Room Efficiency? Otolaryngol Head Neck Surg 2019; 161:787-795. [PMID: 31335269 DOI: 10.1177/0194599819864319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine if attending surgeon presence at the preinduction briefing is associated with a shorter time to incision. STUDY DESIGN Retrospective cohort study and survey. SETTING Tertiary academic medical center. SUBJECTS AND METHODS A retrospective cohort study was conducted of 22,857 operations by 141 attending surgeons across 12 specialties between August 3, 2016, and June 21, 2018. The independent variable was attending surgeon presence at the preinduction briefing. Linear regression models compared time from room entry to incision overall, by service line, and by surgeon. We hypothesized a shorter time to incision when the attending surgeon was present and a larger effect for cases with complex surgical equipment or positioning. A survey was administered to evaluate attending surgeons' perceptions of the briefing, with a response rate of 68% (64 of 94 attending surgeons). RESULTS Cases for which the attending surgeon was present at the preinduction briefing had a statistically significant yet operationally minor reduction in mean time to incision when compared with cases when the attending surgeon was absent. After covariate adjustment, the mean time to incision was associated with an efficiency gain of 1.8 ± 0.5 minutes (mean ± SD; P < .001). There were no statistically significant differences in the subgroups of complex surgical equipment and complex positioning or in secondary analysis comparing service lines. The surgeon was the strongest confounding variable. Survey results demonstrated mild support: 55% of attending surgeons highly prioritized attending the preinduction briefing. CONCLUSION Attending surgeon presence at the preinduction briefing has only a minor effect on efficiency as measured by time to incision.
Collapse
Affiliation(s)
- Rajeev C Saxena
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Mark E Whipple
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | | | - Stuart Solomon
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Christine T Fong
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Bala G Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - John D Lang
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
13
|
Hinds RM, Fiedler DK, Capo JT, Yang SS. Factors Affecting Operative Duration in Isolated Open Carpal Tunnel Release. J Wrist Surg 2019; 8:108-111. [PMID: 30941249 PMCID: PMC6443393 DOI: 10.1055/s-0038-1672154] [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: 04/08/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
Background Open carpal tunnel release (CTR) is one of the most commonly performed operative procedures with operative duration being a primary metric of operating room efficiency. The purpose of this study was to identify factors associated with prolonged operative duration, in performing CTR. Materials and Methods CTR cases performed by a single surgeon from September 2013 to October 2015 were reviewed. Patient age at the time of surgery, sex, location of surgery (specialty orthopaedic hospital versus ambulatory surgery center), body mass index (BMI), American Society of Anesthesiologists classification, total operative duration (TOD), and procedure time (PT) were recorded. Obesity was defined as BMI > 30 and morbid obesity was defined as BMI > 35. Data were analyzed to identify factors associated with prolonged TOD or PT. Results One hundred and nine consecutive patients underwent isolated CTR. Mean age at time of surgery was 62 years (range: 24-92 years). Nonobese patients were found to have significantly shorter TOD than obese patients (22.3 vs. 24.4 minutes). Similarly, patients who were not morbidly obese had significantly shorter TOD than morbidly obese patients (22.6 vs. 26 minutes). No other factors were associated with prolonged TOD. No difference in PT was found between normal weight, obese, and morbidly obese groups. Conclusions TOD, but not procedure time, is significantly affected by obesity. Our findings are relevant when scheduling and preparing obese patients for surgery, which may have a significant impact on health resource utilization. Level of Evidence This is a Level III, economic/decision analysis study.
Collapse
Affiliation(s)
- Richard M. Hinds
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - David K. Fiedler
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - John T. Capo
- Department of Orthopedic Surgery, Robert Wood Johnson University Hospital–Jersey City Medical Center, Jersey City, New Jersey
| | - S. Steven Yang
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| |
Collapse
|
14
|
Improving Operating Room Turnover Time in a New York City Academic Hospital via Lean. Ann Thorac Surg 2019; 107:1011-1016. [DOI: 10.1016/j.athoracsur.2018.11.071] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 11/23/2022]
|
15
|
Abstract
Outpatient surgery, especially in free-standing ambulatory surgery centers (ASC), provides a safe, cost-effective option for a variety of surgical procedures and has become the preferred choice over inpatient and hospital-based outpatient surgery for most hand and wrist procedures. Complication rates after ASC hand surgery are low (0.2%-2.5%). Patient dissatisfaction with ASC surgery is primarily associated with postoperative nausea and vomiting and inadequate pain control.
Collapse
Affiliation(s)
- Norfleet B Thompson
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - James H Calandruccio
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
| |
Collapse
|